Study questions relationship between mode of delivery, pelvic floor symptoms

Women experienced different pelvic floor symptoms depending on their mode of delivery, but those differences were already recognizable even during pregnancy, according to data in the American Journal of Obstetrics & Gynecology.

For example, women with pelvic floor symptoms prior to delivery were more likely to experience a vaginal birth, suggesting that the symptoms may predict the mode of delivery, as opposed to the other way around.

“Several observational and two large prospective longitudinal studies show a strong association between vaginal delivery and pelvic floor dysfunction development,” Tuva Kristine Halle, a faculty of medicine student at the University of Oslo in Norway, and colleagues wrote. “However, antenatal data on pelvic floor symptoms were not considered. The present study provides longitudinal data on pelvic floor symptoms obtained at two time points during the first pregnancy and four time points in the 8 years following the first delivery in women recruited from an unselected childbearing population.”

From 2010 to 2012, Halle and colleagues recruited 300 nulliparous women between 17 and 19 weeks’ gestation during their first pregnancy. Of these, 139 women concurrently participated in a randomized controlled trial (RCT) from 6 weeks to 6 months after their first delivery.

The researchers electronically administered the International Consultation on Incontinence Questionnaire (ICIQ) modules on urinary incontinence, vaginal symptoms, anal incontinence and quality of life to women at 21 and 37 weeks’ gestation and at 6 weeks, 6 months, 12 months and 8 years after their first delivery.

In total, 193 women attended the 8-year follow-up. Among these, 84.2% of women with a normal vaginal delivery, 93.3% of those with an operative vaginal delivery and 76.7% of those with a cesarean delivery had at least one more delivery.

Overall, all delivery groups had low ICIQ scores for all symptoms.

Urinary incontinence

According to the researchers, urinary incontinence scores increased among women who delivered vaginally throughout the study period. On the other hand, urinary incontinence scores decreased during pregnancy and up to 12 months after their first delivery in women who had a cesarean delivery.

However, there were only statistically significant differences at 12 months, with women who had an operative vaginal delivery scoring higher than those who had a cesarean delivery (P = .039).

Vaginal symptoms

For women who delivered vaginally, vaginal symptom scores increased during delivery up to 6 months afterward and decreased at 12 months. Scores for women who had a cesarean delivery decreased during pregnancy and up to 12 months after. Across groups, vaginal symptom scores increased from 12 months to 8 years after delivery.

Women who had operative vaginal deliveries had significantly higher vaginal symptom scores at 6 weeks postpartum compared with those who had a cesarean delivery (P = .041). At 6 months postpartum, scores were higher among women who had an operative vaginal delivery (P = .004) and who had a normal vaginal delivery (P = .002) compared with those who had a cesarean delivery.

Vaginal-related quality of life scores were higher among women who had an operative vaginal delivery compared with those who had a cesarean delivery (P = .047) or normal vaginal delivery (P = .042). Quality of life scores decreased across groups at 8 years.

Bowel control

While anal incontinence scores increased throughout the study period among women who had an operative vaginal delivery, scores among those who had a normal vaginal or cesarean delivery stayed the same. Those who had an operative vaginal delivery had higher scores at 6 weeks (P = .014), 6 months (P = .002) and 12 months (P = .002) compared with those who had a cesarean delivery, as well as higher scores at 6 months (P = .016), 12 months (P = .004) and 8 years (P < .001) compared with those who had a normal vaginal delivery.

Estimated quality of scores associated with bowel control decreased from 21 weeks’ gestation to 12 months postpartum and increased at 8 years across groups, with no statistically significant differences between groups.

“The results from this study give insights into the changes of pelvic floor symptoms in an unselected childbearing population within the first decade after first delivery,” Halle and colleagues wrote.

However, the researchers indicated that “the differences between delivery groups remain speculative” because the ICIQ does not have a concrete threshold to define disorders or dysfunction, or to establish clinically significant differences.

“Better understanding of changes in pelvic floor characteristics during pregnancy and their impact on pelvic floor dysfunction development should be subject for further research,” they wrote.