Obstetric antecedents for postpartum pelvic floor dysfunction.
OBJECTIVE
The purpose of this study was to evaluate prospectively the association between selected obstetric antecedents and symptoms of pelvic floor dysfunction in primiparous women up to 7 months after childbirth.


METHODS
All nulliparous women who were delivered between June 1, 2000, and August 31, 2002, were eligible for a postpartum interview regarding symptoms of persistent pelvic floor dysfunction. Responses from all women who completed a survey at or before their 6-month contraceptive follow-up visit were analyzed. Obstetric antecedents to stress, urge, and anal incontinence were identified, and attributable risks for each factor were calculated.


RESULTS
During the study period, 3887 of 10,643 primiparous women (37%) returned within 219 days of delivery. Symptoms of stress and urge urinary incontinence, were significantly reduced (P < .01) in women who underwent a cesarean delivery. Symptoms of urge urinary incontinence doubled in women who underwent a forceps delivery (P = .04). Symptoms of anal incontinence were increased in women who were delivered of an infant who weighed >4000 g (P = .006) and more than doubled in those women who received oxytocin and had an episiotomy performed (P = .01).


CONCLUSIONS
The likelihood of symptoms of pelvic floor dysfunction up to 7 months after delivery was greater in women who received oxytocin, who underwent a forceps delivery, who were delivered of an infant who weighed >4000 g, or who had an episiotomy performed. Women who underwent a cesarean delivery had fewer symptoms of urge and stress urinary incontinence.
Casey
Brian M
BM
Department of Obstetrics and Gynecology, Southwestern Medical Center, University of Texas, Dallas 75390-9032, USA. brian.casey@utsouthwestern.edu
Schaffer
Joseph I
JI
Bloom
Steven L
SL
Heartwell
Stephen F
SF
McIntire
Donald D
DD
Leveno
Kenneth J
KJ
D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data; D036861:Delivery, Obstetric / Q000009:adverse effects*; D004841:Episiotomy / Q000009:adverse effects; D005242:Fecal Incontinence / Q000209:etiology*; D005260:Female; D005320:Fetal Macrosomia / Q000150:complications; D006801:Humans; D016013:Likelihood Functions; D009772:Obstetrical Forceps / Q000009:adverse effects; D016017:Odds Ratio; D010121:Oxytocin / Q000009:adverse effects; D011446:Prospective Studies; D014549:Urinary Incontinence / Q000209:etiology*; D014550:Urinary Incontinence, Stress / Q000209:etiology*
D010121:Oxytocin