Updates in Gynaecology

Edited by Dr Roman

THE MODE OF DELIVERY VERSUS VAGINAL PROLAPSE

by Jose Roman

THE MODE OF DELIVERY VERSUS VAGINAL PROLAPSE

DELIVERY MODE AFFECTS THE DEVELOPMENT OF PROLAPSE 10 TO 20 YEARS LATER

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Study reported by Johns Hopkins School of Medicine, Baltimore, Maryland (Dec 2018-JAMA)

 

1528 women participated in the study

778 had a caesarean-section

565 had a spontaneous vaginal birth

185 had an operative vaginal birth

All women were recruited 5 to 10 years after their first delivery and followed up annually for up to 9 years. The age at enrolment was 38.3 years. 

Compared with spontaneous vaginal delivery, caesarean-section delivery was associated with significantly lower presence of stress urinary incontinence, overactive bladder, and pelvic organ prolapse, while operative vaginal delivery was associated with significantly higher presence of anal incontinence and pelvic organ prolapse. A larger genital hiatus was associated with increased risk of pelvic organ prolapse independent of delivery mode.

A similar study was published in 2011 (Obstet Gynecol) where 1011 women were recruited for a study 5 to 10 years after first delivery. In this study, compared with caesarean-section without labour, spontaneous vaginal birth was associated with a significantly greater odds of stress incontinence  and prolapse to or beyond the introitus. Operative vaginal birth significantly increased the odds for all pelvic floor disorders, especially prolapse. These results suggest that 7 additional operative births or 9 spontaneous vaginal births, relative to caesarean-section births, would lead to one additional case of prolapse. Among women delivering exclusively by caesarean-section, neither active labour nor complete cervical dilation increased the odds for any pelvic floor disorder considered.

 

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