Pelvic floor disorders: does mode of delivery matter?

  • Journal of Obstetrics and amp; Gynecology and Reproductive Biology

  • curated by Elisabeth Aron, MD, MPH, FACOG
  • Clinical Essentials
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Takeaway

  • Cesarean delivery (CD) reduces the risk of pelvic floor dysfunction compared with vaginal delivery (VD).

Why this matters

  • Both damage to the pelvic floor during VD and increasing uterine volume during pregnancy itself, regardless of mode of delivery, are thought to affect pelvic floor function.
  • When choosing mode of delivery, concern for pelvic floor dysfunction may be taken into consideration.
  • Postpartum rehabilitation should be considered after CD.

Key results

  • Pelvic floor muscle strength was higher in the CD group compared with the VD group (mean difference [MD], −11.94; P<.00001>
  • Muscle voltage was higher in the VD group (MD, −9.45; P<.00001>
  • Maximum urinary flow rate was higher in the VD group (MD, −5.67; P<.00001>
  • Stress urinary incontinence was more common in the VD group (OR, 0.45; P<.00001>
  • Pelvic organ prolapse was more common in the VD group (OR, 0.59; P<.00001>

Study design

  • Systematic search and meta-analysis (n=9 studies included).
  • Funding: None disclosed.

Limitations

  • Limitations related to limitations of original studies.
  • Protection of pelvic floor function may not be enough of a benefit to offer routine elective CD.

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