Effect of delivery mode on postpartum pelvic floor function in primiparous women

Objective To evaluate the pelvic floor functional status of primiparous women undergoing different delivery modes within 2 years postpartum. Methods Primiparous women admitted to the Pelvic Floor Center of Department of Gynecology were enrolled in this study. All participants were divided into the vaginal delivery and cesarean section groups according to the delivery mode. General clinical data were collected. Pelvic Organ Prolapse Quantification （POP-Q），pelvic floor muscle strength and electromyographic analysis were performed. Chronic pelvic pain，urinary and bowel function were evaluated. The Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire -12 （PISQ-12），Incontinence Quality of Life Questionnaire （I-QOL），Pelvic Floor Distress Inventory-20 （PFDI-20），and Self-Rating Depression Scale （SDS） were performed. The differences in pelvic floor anatomy and clinical symptoms in primiparous women were assessed between the vaginal delivery and cesarean section groups. Results A total of 521 primiparous women completed the survey，including 402 cases undergoing vaginal delivery and 119 receiving cesarean section. Primiparous women who underwent vaginal delivery had lower levels of anterior vaginal wall POP-Q，uterine/cervix POP-Q，ClassⅠmuscle strength，ClassⅡmuscle strength， pre-rest， ClassⅠelectromyography，ClassⅡelectromyography，and post-rest compared with those who underwent cesarean section （all P < 0.05）. Moreover，primiparous women who had vaginal delivery were more prone to experiencing stress urinary incontinence （SUI） and lower I-QOL score compared with those receiving cesarean section （both P < 0.05）. In terms of clinical manifestations such as chronic pelvic pain，bowel disorders，sexual dysfunction，and depressive status，there were no significant differences observed between two groups （all P > 0.05）. Conclusions Vaginal delivery may be a risk factor for the increased incidence of postpartum pelvic organ prolapse （POP） and SUI in primiparous women. In clinical practice， early postpartum pelvic floor rehabilitation exercises or interventions should be emphasized for primiparous women，especially for the changes in urinary function