Skip to main content
Top
Published in: BMC Pregnancy and Childbirth 1/2024

Open Access 01-12-2024 | Sectio Caesarea | Research

Association of the second birth mode of delivery and interval with maternal pelvic floor changes: a prospective cohort study

Authors: Xiaoli Wu, Xiu Zheng, Xiaohong Yi, Bolin Fan

Published in: BMC Pregnancy and Childbirth | Issue 1/2024

Login to get access

Abstract

Background

This study aimed to explore the association of the second birth delivery mode and interval with maternal pelvic floor changes.

Methods

This prospective cohort study included women who had a first delivery and were in weeks 36–41 of a subsequent pregnancy at Panzhihua Central Hospital between July 2017 and June 2018. The primary outcomes of the study were the hiatus area at 6 months postpartum and bladder neck (mm) at rest and during a maximum Valsalva maneuver.

Results

There were 112 women with vaginal delivery and 182 with Cesarean section. The hiatus area and hiatus circumference decreased at all time points (all P < 0.001). The women with Cesarean section had a smaller hiatus area and circumference (P < 0.001 and P < 0.001). The hiatus diameters decreased with time in both groups (all P < 0.001) and were smaller after Cesarean section (both P < 0.001). The bladder neck at maximum Valsalva increased with time (all P < 0.001) without significant differences between the two groups. Finally, the proportion of patients with POP-Q stage 0/I increased with time in both groups (all P < 0.001), with the proportions being higher in the Cesarean group (P = 0.002). The birth interval was negatively correlated with the hiatus area (B=-0.17, 95%CI: -0.25, -0.08, P < 0.001) and positively correlated with the bladder neck at rest (B = 0.22, 95%CI: 0.08, 0.35, P = 0.001) and at maximum Valsalva (B = 0.85, 95%CI: 0.65, 1.05, P < 0.001).

Conclusions

In conclusion, the mode of delivery at the second birth could influence the hiatus area and circumference and bladder neck size. The birth interval was negatively correlated with the hiatus area and positively correlated with the bladder neck at rest and at maximum Valsalva.
Literature
1.
go back to reference Hagen S, Stark D. Conservative prevention and management of pelvic organ prolapse in women. Cochrane Database Syst Rev 2011:CD003882. Hagen S, Stark D. Conservative prevention and management of pelvic organ prolapse in women. Cochrane Database Syst Rev 2011:CD003882.
2.
go back to reference McCool-Myers M, Theurich M, Zuelke A, Knuettel H, Apfelbacher C. Predictors of female sexual dysfunction: a systematic review and qualitative analysis through gender inequality paradigms. BMC Womens Health. 2018;18:108.CrossRefPubMedPubMedCentral McCool-Myers M, Theurich M, Zuelke A, Knuettel H, Apfelbacher C. Predictors of female sexual dysfunction: a systematic review and qualitative analysis through gender inequality paradigms. BMC Womens Health. 2018;18:108.CrossRefPubMedPubMedCentral
3.
go back to reference Fialkow MF, Newton KM, Lentz GM, Weiss NS. Lifetime risk of surgical management for pelvic organ prolapse or urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19:437–40.CrossRefPubMed Fialkow MF, Newton KM, Lentz GM, Weiss NS. Lifetime risk of surgical management for pelvic organ prolapse or urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19:437–40.CrossRefPubMed
4.
go back to reference Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol. 1997;89:501–6.CrossRefPubMed Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol. 1997;89:501–6.CrossRefPubMed
5.
go back to reference Smith FJ, Holman CD, Moorin RE, Tsokos N. Lifetime risk of undergoing surgery for pelvic organ prolapse. Obstet Gynecol. 2010;116:1096–100.CrossRefPubMed Smith FJ, Holman CD, Moorin RE, Tsokos N. Lifetime risk of undergoing surgery for pelvic organ prolapse. Obstet Gynecol. 2010;116:1096–100.CrossRefPubMed
6.
go back to reference Boyadzhyan L, Raman SS, Raz S. Role of static and dynamic MR imaging in surgical pelvic floor dysfunction. Radiographics. 2008;28:949–67.CrossRefPubMed Boyadzhyan L, Raman SS, Raz S. Role of static and dynamic MR imaging in surgical pelvic floor dysfunction. Radiographics. 2008;28:949–67.CrossRefPubMed
7.
go back to reference Spence-Jones C, Kamm MA, Henry MM, Hudson CN. Bowel dysfunction: a pathogenic factor in uterovaginal prolapse and urinary stress incontinence. Br J Obstet Gynaecol. 1994;101:147–52.CrossRefPubMed Spence-Jones C, Kamm MA, Henry MM, Hudson CN. Bowel dysfunction: a pathogenic factor in uterovaginal prolapse and urinary stress incontinence. Br J Obstet Gynaecol. 1994;101:147–52.CrossRefPubMed
8.
go back to reference Asfour V, Digesu GA, Fernando R, Khullar V. Ultrasound imaging of the perineal body: a useful clinical tool. Int Urogynecol J. 2020;31:1197–202.CrossRefPubMed Asfour V, Digesu GA, Fernando R, Khullar V. Ultrasound imaging of the perineal body: a useful clinical tool. Int Urogynecol J. 2020;31:1197–202.CrossRefPubMed
9.
10.
go back to reference Hainsworth AJ, Solanki D, Schizas AM, Williams AB. Total pelvic floor ultrasound for pelvic floor defaecatory dysfunction: a pictorial review. Br J Radiol. 2015;88:20150494.CrossRefPubMedPubMedCentral Hainsworth AJ, Solanki D, Schizas AM, Williams AB. Total pelvic floor ultrasound for pelvic floor defaecatory dysfunction: a pictorial review. Br J Radiol. 2015;88:20150494.CrossRefPubMedPubMedCentral
11.
go back to reference Dalpiaz O, Curti P. Role of perineal ultrasound in the evaluation of urinary stress incontinence and pelvic organ prolapse: a systematic review. Neurourol Urodyn. 2006;25:301–6. discussion 307.CrossRefPubMed Dalpiaz O, Curti P. Role of perineal ultrasound in the evaluation of urinary stress incontinence and pelvic organ prolapse: a systematic review. Neurourol Urodyn. 2006;25:301–6. discussion 307.CrossRefPubMed
12.
go back to reference Lal M, C HM, Callender R, Radley S. Does cesarean delivery prevent anal incontinence? Obstet Gynecol. 2003;101:305–12.PubMed Lal M, C HM, Callender R, Radley S. Does cesarean delivery prevent anal incontinence? Obstet Gynecol. 2003;101:305–12.PubMed
13.
go back to reference Yilmaz E, Nas T, Korucuoglu U, Guler I. Manometric evaluation of anal sphincter function after vaginal and cesarean delivery. Int J Gynaecol Obstet. 2008;103:162–5.CrossRefPubMed Yilmaz E, Nas T, Korucuoglu U, Guler I. Manometric evaluation of anal sphincter function after vaginal and cesarean delivery. Int J Gynaecol Obstet. 2008;103:162–5.CrossRefPubMed
14.
go back to reference Dietz HP, Gillespie AV, Phadke P. Avulsion of the pubovisceral muscle associated with large vaginal tear after normal vaginal delivery at term. Aust N Z J Obstet Gynaecol. 2007;47:341–4.CrossRefPubMed Dietz HP, Gillespie AV, Phadke P. Avulsion of the pubovisceral muscle associated with large vaginal tear after normal vaginal delivery at term. Aust N Z J Obstet Gynaecol. 2007;47:341–4.CrossRefPubMed
15.
17.
go back to reference Handa VL, Blomquist JL, Knoepp LR, Hoskey KA, McDermott KC, Munoz A. Pelvic floor disorders 5–10 years after vaginal or cesarean childbirth. Obstet Gynecol. 2011;118:777–84.CrossRefPubMedPubMedCentral Handa VL, Blomquist JL, Knoepp LR, Hoskey KA, McDermott KC, Munoz A. Pelvic floor disorders 5–10 years after vaginal or cesarean childbirth. Obstet Gynecol. 2011;118:777–84.CrossRefPubMedPubMedCentral
18.
go back to reference Handa VL, Blomquist JL, McDermott KC, Friedman S, Munoz A. Pelvic floor disorders after vaginal birth: effect of episiotomy, perineal laceration, and operative birth. Obstet Gynecol. 2012;119:233–9.CrossRefPubMedPubMedCentral Handa VL, Blomquist JL, McDermott KC, Friedman S, Munoz A. Pelvic floor disorders after vaginal birth: effect of episiotomy, perineal laceration, and operative birth. Obstet Gynecol. 2012;119:233–9.CrossRefPubMedPubMedCentral
19.
go back to reference Barca JA, Bravo C, Pintado-Recarte MP, Asunsolo A, Cueto-Hernandez I, Ruiz-Labarta J, Bujan J, Ortega MA, De Leon-Luis JA. Pelvic floor morbidity following vaginal delivery versus cesarean delivery: systematic review and Meta-analysis. J Clin Med 2021, 10. Barca JA, Bravo C, Pintado-Recarte MP, Asunsolo A, Cueto-Hernandez I, Ruiz-Labarta J, Bujan J, Ortega MA, De Leon-Luis JA. Pelvic floor morbidity following vaginal delivery versus cesarean delivery: systematic review and Meta-analysis. J Clin Med 2021, 10.
20.
go back to reference Patel DA, Xu X, Thomason AD, Ransom SB, Ivy JS, DeLancey JO. Childbirth and pelvic floor dysfunction: an epidemiologic approach to the assessment of prevention opportunities at delivery. Am J Obstet Gynecol. 2006;195:23–8.CrossRefPubMedPubMedCentral Patel DA, Xu X, Thomason AD, Ransom SB, Ivy JS, DeLancey JO. Childbirth and pelvic floor dysfunction: an epidemiologic approach to the assessment of prevention opportunities at delivery. Am J Obstet Gynecol. 2006;195:23–8.CrossRefPubMedPubMedCentral
21.
go back to reference Mant J, Painter R, Vessey M. Epidemiology of genital prolapse: observations from the Oxford Family Planning Association Study. Br J Obstet Gynaecol. 1997;104:579–85.CrossRefPubMed Mant J, Painter R, Vessey M. Epidemiology of genital prolapse: observations from the Oxford Family Planning Association Study. Br J Obstet Gynaecol. 1997;104:579–85.CrossRefPubMed
22.
go back to reference Rortveit G, Daltveit AK, Hannestad YS, Hunskaar S, Norwegian ES. Urinary incontinence after vaginal delivery or cesarean section. N Engl J Med. 2003;348:900–7.CrossRefPubMed Rortveit G, Daltveit AK, Hannestad YS, Hunskaar S, Norwegian ES. Urinary incontinence after vaginal delivery or cesarean section. N Engl J Med. 2003;348:900–7.CrossRefPubMed
23.
go back to reference Jundt K, Scheer I, von Bodungen V, Krumbachner F, Friese K, Peschers UM. What harm does a second delivery to the pelvic floor? Eur J Med Res. 2010;15:362–6.CrossRefPubMedPubMedCentral Jundt K, Scheer I, von Bodungen V, Krumbachner F, Friese K, Peschers UM. What harm does a second delivery to the pelvic floor? Eur J Med Res. 2010;15:362–6.CrossRefPubMedPubMedCentral
24.
go back to reference Horak TA, Guzman-Rojas RA, Shek KL, Dietz HP. Pelvic floor trauma: does the second baby matter? Ultrasound Obstet Gynecol. 2014;44:90–4.CrossRefPubMed Horak TA, Guzman-Rojas RA, Shek KL, Dietz HP. Pelvic floor trauma: does the second baby matter? Ultrasound Obstet Gynecol. 2014;44:90–4.CrossRefPubMed
26.
go back to reference Dietz HP, Hoyte LPJ, Steensma AB. Atlas of Pelvic Floor Ultrasound. London: Springer-; 2008.CrossRef Dietz HP, Hoyte LPJ, Steensma AB. Atlas of Pelvic Floor Ultrasound. London: Springer-; 2008.CrossRef
27.
go back to reference Maher C, Feiner B, Baessler K, Schmid C. Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev 2013:CD004014. Maher C, Feiner B, Baessler K, Schmid C. Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev 2013:CD004014.
28.
go back to reference Muir TW, Stepp KJ, Barber MD. Adoption of the pelvic organ prolapse quantification system in peer-reviewed literature. Am J Obstet Gynecol. 2003;189:1632–5. discussion 1635–1636.CrossRefPubMed Muir TW, Stepp KJ, Barber MD. Adoption of the pelvic organ prolapse quantification system in peer-reviewed literature. Am J Obstet Gynecol. 2003;189:1632–5. discussion 1635–1636.CrossRefPubMed
29.
go back to reference Treszezamsky AD, Rascoff L, Shahryarinejad A, Vardy MD. Use of pelvic organ prolapse staging systems in published articles of selected specialized journals. Int Urogynecol J. 2010;21:359–63.CrossRefPubMed Treszezamsky AD, Rascoff L, Shahryarinejad A, Vardy MD. Use of pelvic organ prolapse staging systems in published articles of selected specialized journals. Int Urogynecol J. 2010;21:359–63.CrossRefPubMed
30.
go back to reference Vierhout ME, Stoutjesdijk J, Spruijt J. A comparison of preoperative and intraoperative evaluation of patients undergoing pelvic reconstructive surgery for pelvic organ prolapse using the pelvic organ prolapse quantification system. Int Urogynecol J Pelvic Floor Dysfunct. 2006;17:46–9.CrossRefPubMed Vierhout ME, Stoutjesdijk J, Spruijt J. A comparison of preoperative and intraoperative evaluation of patients undergoing pelvic reconstructive surgery for pelvic organ prolapse using the pelvic organ prolapse quantification system. Int Urogynecol J Pelvic Floor Dysfunct. 2006;17:46–9.CrossRefPubMed
31.
go back to reference Manonai J, Mouritsen L, Palma P, Contreras-Ortiz O, Korte JE, Swift S. The inter-system association between the simplified pelvic organ prolapse quantification system (S-POP) and the standard pelvic organ prolapse quantification system (POPQ) in describing pelvic organ prolapse. Int Urogynecol J. 2011;22:347–52.CrossRefPubMed Manonai J, Mouritsen L, Palma P, Contreras-Ortiz O, Korte JE, Swift S. The inter-system association between the simplified pelvic organ prolapse quantification system (S-POP) and the standard pelvic organ prolapse quantification system (POPQ) in describing pelvic organ prolapse. Int Urogynecol J. 2011;22:347–52.CrossRefPubMed
32.
go back to reference Romano M, Cacciatore A, Giordano R, La Rosa B. Postpartum period: three distinct but continuous phases. J Prenat Med. 2010;4:22–5.PubMedPubMedCentral Romano M, Cacciatore A, Giordano R, La Rosa B. Postpartum period: three distinct but continuous phases. J Prenat Med. 2010;4:22–5.PubMedPubMedCentral
33.
go back to reference Yang XJ, Sun Y. Comparison of caesarean section and vaginal delivery for pelvic floor function of parturients: a meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2019;235:42–8.CrossRefPubMed Yang XJ, Sun Y. Comparison of caesarean section and vaginal delivery for pelvic floor function of parturients: a meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2019;235:42–8.CrossRefPubMed
34.
35.
go back to reference Baud D, Sichitiu J, Lombardi V, De Rham M, Meyer S, Vial Y, Achtari C. Comparison of pelvic floor dysfunction 6 years after uncomplicated vaginal versus elective cesarean deliveries: a cross-sectional study. Sci Rep. 2020;10:21509.CrossRefPubMedPubMedCentralADS Baud D, Sichitiu J, Lombardi V, De Rham M, Meyer S, Vial Y, Achtari C. Comparison of pelvic floor dysfunction 6 years after uncomplicated vaginal versus elective cesarean deliveries: a cross-sectional study. Sci Rep. 2020;10:21509.CrossRefPubMedPubMedCentralADS
36.
go back to reference Zhao Y, Zou L, Xiao M, Tang W, Niu HY, Qiao FY. Effect of different delivery modes on the short-term strength of the pelvic floor muscle in Chinese primipara. BMC Pregnancy Childbirth. 2018;18:275.CrossRefPubMedPubMedCentral Zhao Y, Zou L, Xiao M, Tang W, Niu HY, Qiao FY. Effect of different delivery modes on the short-term strength of the pelvic floor muscle in Chinese primipara. BMC Pregnancy Childbirth. 2018;18:275.CrossRefPubMedPubMedCentral
37.
go back to reference Chan SSC, Cheung RYK, Lee LL, Chung TKH. Longitudinal pelvic floor biometry: which factors affect it? Ultrasound Obstet Gynecol. 2018;51:246–52.CrossRefPubMed Chan SSC, Cheung RYK, Lee LL, Chung TKH. Longitudinal pelvic floor biometry: which factors affect it? Ultrasound Obstet Gynecol. 2018;51:246–52.CrossRefPubMed
38.
go back to reference Bujold E, Mehta SH, Bujold C, Gauthier RJ. Interdelivery interval and uterine rupture. Am J Obstet Gynecol. 2002;187:1199–202.CrossRefPubMed Bujold E, Mehta SH, Bujold C, Gauthier RJ. Interdelivery interval and uterine rupture. Am J Obstet Gynecol. 2002;187:1199–202.CrossRefPubMed
Metadata
Title
Association of the second birth mode of delivery and interval with maternal pelvic floor changes: a prospective cohort study
Authors
Xiaoli Wu
Xiu Zheng
Xiaohong Yi
Bolin Fan
Publication date
01-12-2024
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2024
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-024-06366-6

Other articles of this Issue 1/2024

BMC Pregnancy and Childbirth 1/2024 Go to the issue