Long-term consequences of vaginal delivery on the pelvic floor. A comparison with caesarean section in one-para women

Abstract Long-term consequences of vaginal delivery on the pelvic floor: A comparison with caesarean section in one-parae women Urinary incontinence (UI), symptomatic pelvic organ prolapse (sPOP), and faecal and anal incontinence (FI and AI) are the three major sequelae of childbirth. It has as yet not been finally settled whether in the long term vaginal delivery (VD) is detrimental to pelvic floor function in comparison to caesarean section (CS). The aim of this thesis was to study the influence of childbirth on the long-term prevalence of these pelvic floor disorders (PFD) and their putative obstetric and non-obstetric risk factors by comparing two large cohorts of women after one VD compared to one CS in 2008, 20 years after childbirth. This national cohort study included 5236 one-parae women who gave birth in 1985-1988 and returned a questionnaire on PFD in 2008. Self-reported information was linked to obstetric data from the Swedish Medical Birth Register. The prevalence of UI; UI for more than 10 years; subtypes of UI; severe, significant and bothersome UI; sPOP; AI, severe AI; FI; were consistently higher after VD compared to CS. After one VD the prevalence of FI increased by about 4%, UI by 12% and sPOP by about 8%, compared to one CS. After a VD women with sPOP had an almost tripled prevalence of UI compared with CS. A ≥2nd degree perineal tear was associated with an almost doubled prevalence of FI. Episiotomy during VD was protective for FI. BMI was second to VD the most important risk factor for PFD, which is important since it is modifiable. In conclusion, one single VD was associated with an increased prevalence of all three of the most important pelvic floor disorders - UI, sPOP, and FI - 20 years after giving birth to one child. Key-words; Vaginal delivery, caesarean section, urinary incontinence, subtypes, bothersome, severity, pelvic organ prolapse, anal incontinence, faecal incontinence, long-term, epidemiology, body mass index, episiotomy, perineal tear. ISBN 978-91-628-8594-6 http://hdl.handle.net/2077/3170

Temporal trends in obstetric anal sphincter injury from the first vaginal delivery in Austria, Canada, Norway, and Sweden

Introduction Obstetric anal sphincter injuries (OASI) are severe complications that can cause considerable short- and long-term morbidity. Austria, Canada, Norway, and Sweden have similar socio-economic characteristics, and all four countries have access to national birth registers. In this study, we hypothesized that the incidence of OASI should be very similar for different obstetric scenarios in these four countries. Therefore, the aim was to compare the incidence of OASI in these four countries in primiparous women, with spontaneous or instrumental delivery (vacuum or forceps), and in women with a first vaginal birth after cesarean section (VBAC). Material and methods Aggregated data on 1 933 930 vaginally delivered primiparous women and women with VBAC were retrieved from the birth registers gathered in Austria, Canada, Norway, and Sweden. The annual rate of OASI (ICD-10 codes O70.2–O70.3) was presented as the percentage of women with a spontaneous delivery, vacuum or forceps delivery, and a VBAC during the period 2004–2016. Results The incidence of OASI varied considerably between countries and over time. Canada and Sweden had the highest rates, and Austria and Norway the lowest. In Norway, the rate of OASI decreased consistently for all types of deliveries after introducing a perineal protection program in 2004 (p < 0.001). During vacuum delivery, the incidence of OASI varied between countries from 4.1% to 15.5% across the study period. In Canada and Norway, the rate of OASI after a forceps delivery was similar in 2004 at ~20% and with differing trajectories to 24.3% (β 0.49) and 6.2% (β −1.15) (trend, all p < 0.001) in 2016. Conclusions This comparative register study suggests that there may be considerable potential for lowering the incidence of OASI. The perineal protection program implemented by Norway has been successful. Each country should critically, without prejudice, analyze their current clinical practices and rate of OASI and consider the best preventive strategy

Consensus Statement of the European Urology Association and the European Urogynaecological Association on the Use of Implanted Materials for Treating Pelvic Organ Prolapse and Stress Urinary Incontinence

Surgical nonautologous meshes have been used for several decades to repair abdominal wall herniae. Implantable materials have been adopted for the treatment of female and male stress urinary incontinence (SUI) and female pelvic organ prolapse (POP).status: publishe