Risk for incontinence, other pelvic floor disorders linked to childbirth mode

  • Blomquist JL & al.
  • JAMA
  • 18 Dec 2018

  • curated by Craig Hicks
  • Clinical Essentials
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Takeaway

  • Cesarean delivery is associated with a lower risk than spontaneous vaginal delivery for stress urinary incontinence (SUI), overactive bladder (OAB), and pelvic organ prolapse (POP), whereas operative vaginal delivery is linked to a higher risk for anal incontinence (AI) and POP.

Why this matters

  • Childbirth-associated pelvic floor disorders affect approximately 25% of women in the United States, but little is known about their course and progression over time.

Key results

  • 15-year cumulative incidences of pelvic floor disorders after spontaneous vaginal delivery (95% CIs):
    • SUI: 34.3% (29.9%-38.6%).
    • OAB: 21.8% (17.8%-25.7%).
    • AI: 30.6% (26.4%-34.9%).
    • POP: 30.0% (25.1%-34.9%).
  • Risk after cesarean delivery (adjusted HRs; 95% CIs):
    • SUI: 0.46 (0.32-0.67).
    • OAB: 0.51 (0.34-0.76).
    • POP: 0.28 (0.19-0.42).
  • Risk after operative vaginal delivery (adjusted HRs; 95% CIs):
    • AI: 1.75 (1.14-2.68).
    • POP: 1.88 (1.28-2.78).

Study design

  • Researchers studied women 5-10 years after first delivery and followed-up annually for ≤9 years (N=1528: 778 cesarean, 565 spontaneous vaginal births, 185 operative vaginal births).
  • Funding: NIH.

Limitations

  • The study was single center and had a small sample size.

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