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International Urogynecology Journal

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Open Access 01-10-2019 | Urinary Incontinence | Original Article

The effect of the first vaginal birth on pelvic floor anatomy and dysfunction

Authors: Iva Urbankova, Klara Grohregin, Jiri Hanacek, Michal Krcmar, Jaroslav Feyereisl, Jan Deprest, Ladislav Krofta

Published in: International Urogynecology Journal | Issue 10/2019

Abstract

Introduction and hypothesis

First vaginal delivery severely interferes with pelvic floor anatomy and function. This study determines maternal and pregnancy-related risk factors for pelvic floor dysfunction (PFD), including urinary incontinence (UI), urgency, anal incontinence (AI), pelvic organ prolapse (POP) and levator ani muscle (LAM) avulsion.

Methods

This is a single-centre prospective observational cohort study on healthy women in their first singleton pregnancy. All underwent clinical and 3D transperineal ultrasound examination at 6 weeks and 12 months postpartum. Objective outcomes were POP-Q and presence or absence of LAM trauma. Functional outcomes were measured by the ICIQ-SF and PISQ 12. Multivariate regression was performed to determine birth and maternal habitus-related risk factors for UI, urgency, AI, dyspareunia, LAM avulsion and ballooning.

Results

Nine hundred eighty-seven women were included. Risk factors for UI were maternal age per year of age (OR: 1.09; 95% CI: 1.04–1.13; p = 0.0001) and BMI before pregnancy (OR: 1.08; 95% CI: 1.04–1.13; p = 0.001); for POP stage II+ maternal age (OR: 1.08; 95% CI: 1.08–1.14; p = 0.005). Avulsion was more likely after forceps (OR: 3.22; 95% CI:1.54–8.22; p = 0.015) but less likely after epidural analgesia (OR: 0.58; 95% CI: 0.37–0.90; p = 0.015) and grade I perineal rupture (OR: 0.50; 95% CI: 0.29–0.85; p = 0.012). Ballooning was more likely at increased maternal age (OR: 1.08; 95% CI: 1.02–1.13; p = 0.005), epidural (OR: 1.64; 95% CI: 1.06–2.55; p = 0.027) and grade I perineal rupture (OR: 1.79; 95% CI: 1.10–2.90; p = 0.018).

Conclusion

Though maternal characteristics at birth such as age or BMI increase the risk of PFD, labour and birth factors play a similarly important role. The most critical risk factor for MLA avulsion was forceps delivery, while an epidural had a protective effect.

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Title: The effect of the first vaginal birth on pelvic floor anatomy and dysfunction
Authors: Iva Urbankova
Klara Grohregin
Jiri Hanacek
Michal Krcmar
Jaroslav Feyereisl
Jan Deprest
Ladislav Krofta
Publication date: 01-10-2019
Publisher: Springer International Publishing
Keywords: Urinary Incontinence
Urinary Incontinence
Episiotomy
Published in: International Urogynecology Journal / Issue 10/2019
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-019-04044-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The effect of the first vaginal birth on pelvic floor anatomy and dysfunction

Abstract

Introduction and hypothesis

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction and hypothesis

Methods

Results

Conclusion

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