title: Pelvic floor disorders 5-10 years after vaginal or cesarean childbirth.
abstract: OBJECTIVE
  To estimate differences in pelvic floor disorders by mode of delivery.
  
  
  METHODS
  We recruited 1,011 women for a longitudinal cohort study 5-10 years after first delivery. Using hospital records, we classified each birth as: cesarean without labor, cesarean during active labor, cesarean after complete cervical dilation, spontaneous vaginal birth, or operative vaginal birth. At enrollment, stress incontinence, overactive bladder, anal incontinence, and prolapse symptoms were assessed with a validated questionnaire. Pelvic organ support was assessed using the Pelvic Organ Prolapse Quantification system. Logistic regression analysis was used to estimate the relative odds of each pelvic floor disorder by obstetric history, adjusting for relevant confounders.
  
  
  RESULTS
  Compared with cesarean without labor, spontaneous vaginal birth was associated with a significantly greater odds of stress incontinence (odds ratio [OR] 2.9, 95% confidence interval [CI] 1.5-5.5) and prolapse to or beyond the hymen (OR 5.6, 95% CI 2.2-14.7). Operative vaginal birth significantly increased the odds for all pelvic floor disorders, especially prolapse (OR 7.5, 95% CI 2.7-20.9). These results suggest that 6.8 additional operative births or 8.9 spontaneous vaginal births, relative to cesarean births, would lead to one additional case of prolapse. Among women delivering exclusively by cesarean, neither active labor nor complete cervical dilation increased the odds for any pelvic floor disorder considered, although the study had less than 80% power to detect a doubling of the odds with these exposures.
  
  
  CONCLUSIONS
  Although spontaneous vaginal delivery was significantly associated with stress incontinence and prolapse, the most dramatic risk was associated with operative vaginal birth.
  
  
  METHODS
  II.
authors: Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Vhanda1@jhmi.edu
authors: Victoria L
authors: VL
authors: Handa
authors: Joan L
authors: JL
authors: Blomquist
authors: Leise R
authors: LR
authors: Knoepp
authors: Kay A
authors: KA
authors: Hoskey
authors: Kelly C
authors: KC
authors: McDermott
authors: Alvaro
authors: A
authors: Muñoz
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D005242:Fecal Incontinence / Q000209:etiology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D007744:Obstetric Labor Complications / Q000209:etiology*; D036801:Parturition; D017773:Pelvic Floor / Q000503:physiopathology; D056887:Pelvic Organ Prolapse / Q000209:etiology*; D011247:Pregnancy; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D053201:Urinary Bladder, Overactive / Q000209:etiology*; D014550:Urinary Incontinence, Stress / Q000209:etiology*