Obstetric management of a woman's first delivery and the implications for pelvic floor surgery in later life.
OBJECTIVE
To determine the influence of intrapartum care during a first delivery on the risk of pelvic floor surgery in later life.


METHODS
Nested case-control study with record linkage of a historical cohort and a current morbidity database.


METHODS
Hospital births in Dundee 1952-1966.


METHODS
The 7556 primiparous women from the Walker cohort.


METHODS
The cases (n= 352) were women who delivered a first singleton baby at term (> or =37 weeks) and subsequently had pelvic floor surgery. Controls (n= 1403) were women who delivered their first baby during the same time period and did not undergo surgery. Univariate and multivariate logistic regression analyses were performed taking account of demographic, anthropometric and obstetric factors.


METHODS
Pelvic floor surgery.


RESULTS
Caesarean section was associated with a reduced risk of pelvic floor surgery compared with spontaneous vaginal delivery (odds ratio 0.16, 95% CI 0.05-0.55). Forceps delivery and infant birthweight >4.0 kg were not identified as significant risk factors (OR 0.94, 95% CI 0.71, 1.25, and OR 0.94, 95% CI 0.50, 1.75, respectively). Episiotomy and prolonged labour (>12 hours) may be associated risk factors but were of borderline significance (OR 1.46, 95% CI 0.99, 2.10, and OR 1.51, 95% CI 1.00, 2.27).


CONCLUSIONS
Caesarean section in a first pregnancy appears to protect against pelvic floor surgery in later life.
Uma
Ramalingam
R
Division of Maternal and Child Health Sciences, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK.
Libby
Gillian
G
Murphy
Deirdre J
DJ
D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D002585:Cesarean Section / Q000706:statistics & numerical data; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000009:adverse effects*; D005260:Female; D005865:Gestational Age; D006801:Humans; D008875:Middle Aged; D010298:Parity; D017773:Pelvic Floor / Q000601:surgery*; D011247:Pregnancy; D011295:Prenatal Care / Q000379:methods*; D011391:Prolapse; D012044:Regression Analysis; D012307:Risk Factors; D012606:Scotland / Q000453:epidemiology; D014550:Urinary Incontinence, Stress / Q000453:epidemiology