Pelvic floor dysfunction after vaginal and cesarean delivery among singleton primiparas.
OBJECTIVE
To compare the prevalence of pelvic floor dysfunction symptoms, including pelvic organ prolapse (POP), urinary incontinence (UI), and fecal incontinence (FI) among primiparous women after vaginal and cesarean delivery.


METHODS
In a prospective cohort study at a University hospital in the Czech Republic, singleton primiparas with cephalic presentation who delivered at term were enrolled between 2002 and 2007. In 2013, 5-10 years after delivery, women who had not delivered again completed an internet-based survey about current symptoms of POP, UI, and FI, which were evaluated using validated questionnaires. The relative risk (RR) of POP, UI, and FI symptoms was calculated.


RESULTS
Complete questionnaire data were obtained from 641 women who delivered vaginally and 224 who delivered by cesarean. The mean UI score (ICIQ-SF) was 2.3 ± 3.6 in the vaginal group and 1.0 ± 2.7 in the cesarean group (P=0.005). The mean POP scores (POPDI-6) were 2.2 ± 2.3 and 2.1 ± 2.0, respectively (P=0.944). The mean Wexner scores to evaluate FI were 1.3 ± 1.7 and 1.0 ± 1.5, respectively (P=0.220). The RR of pelvic floor dysfunction after vaginal delivery was highest for women with UI symptoms (RR 1.15, 95% confidence interval 0.92-1.42).


CONCLUSIONS
Significant differences in the occurrence of symptoms of UI were observed after vaginal delivery as compared with cesarean delivery. ClinicalTrials.gov: NCT02661867.
Department of Obstetrics and Gynecology, Brno University Hospital and Masaryk University Medical School, Brno, Czech Republic.
Martin
M
Huser
Department of Obstetrics and Gynecology, Brno University Hospital and Masaryk University Medical School, Brno, Czech Republic.
Petr
P
Janku
Department of Obstetrics and Gynecology, Brno University Hospital and Masaryk University Medical School, Brno, Czech Republic.
Robert
R
Hudecek
Institute of Biostatistics and Analyses, Masaryk University Medical School, Brno, Czech Republic.
Zuzana
Z
Zbozinkova
Czech Institute of Informatics, Robotics and Cybernetics, Czech Technical University, Prague, Czech Republic.
Miroslav
M
Bursa
Department of Obstetrics and Gynecology, University Hospital Ostrava and University of Ostrava Medical School, Ostrava, Czech Republic.
Vit
V
Unzeitig
Department of Obstetrics and Gynecology, Brno University Hospital and Masaryk University Medical School, Brno, Czech Republic.
Pavel
P
Ventruba
D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D018153:Czech Republic / Q000453:epidemiology; D036861:Delivery, Obstetric / Q000009:adverse effects*; D005260:Female; D006801:Humans; D020407:Internet; D010298:Parity; D059952:Pelvic Floor Disorders / Q000453:epidemiology* / Q000209:etiology; D056887:Pelvic Organ Prolapse / Q000453:epidemiology* / Q000209:etiology; D011247:Pregnancy; D011446:Prospective Studies; D011644:Puerperal Disorders / Q000453:epidemiology; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016387:Women's Health
Cesarean delivery; Childbirth; Fecal incontinence; Pelvic floor dysfunction; Pelvic organ prolapse; Urinary incontinence; Vaginal delivery