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Original Research: Gynecology|Articles in Press

Pelvic floor symptoms from first pregnancy up to 8 years after the first delivery: a longitudinal study.

Published:June 16, 2022DOI:https://doi.org/10.1016/j.ajog.2022.06.020
Pelvic floor symptoms from first pregnancy up to 8 years after the first delivery: a longitudinal study.
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      Abstract

      Background

      Despite the strong association between vaginal childbirth and pelvic floor dysfunction, genetic factors, pregnancy, advancing age, and lifestyle also play a role. The pelvic floor undergoes substantial changes during pregnancy which may contribute to pelvic floor dysfunction. On the other hand, these changes may be favorable to allow for vaginal delivery. However, there is a lack of studies assessing pelvic floor symptoms over time according to delivery mode, which includes women prior to delivery.

      Objective

      The aim of this study was to describe urinary incontinence, vaginal symptoms, and bowel control symptoms from 21 weeks of gestation in the first pregnancy and up to 8 years after the first delivery, stratified by delivery mode.

      Study design

      This is a longitudinal observational cohort study. 300 nulliparous women were recruited during their first pregnancy. Pelvic floor symptoms were assessed at 21 and 37 weeks of gestation, and 6 weeks, 6 months, 12 months and 8 years after first delivery using the International Consultation on Incontinence Questionnaire (ICIQ) modules: the urinary incontinence sum score; the weighted vaginal symptom sum score; the vaginal-associated quality of life score; the bowel control sum score; and the bowel-associated quality of life sum score. Delivery mode at first delivery defined delivery groups as: normal vaginal, operative vaginal and cesarean delivery. A linear mixed model analysis was used to assess symptom scores over time and to assess the differences in symptom scores between the delivery groups.

      Results

      Of the 300 women included in the study, of which 193 attended the 8-year follow-up. Pelvic floor symptoms differed in women with vaginal and cesarean delivery. The symptom scores showed a non-linear statistically significant trend. In women, who delivered vaginally, there was an increase of urinary incontinence and vaginal symptom scores already during pregnancy. In women, who later delivered by cesarean, there was a decrease of symptoms scores during pregnancy, and overall lower symptom scores compared to women with vaginal delivery until 12 months after first delivery. Pelvic floor symptoms scores increased from 12 months to 8 years after the first delivery and exceeded pregnancy levels in all delivery groups, however overall symptom scores were low. Differences between delivery groups were not statistically significant.

      Conclusion

      Pelvic floor symptoms differed in women with vaginal and cesarean delivery from the first pregnancy up to 8 years after the first delivery. These differences were recognizable already prior to first delivery.

      Keywords

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      Article Info

      Publication History

      Accepted: June 8, 2022
      Received in revised form: May 23, 2022
      Received: February 2, 2022

      Publication stage

      In Press Journal Pre-Proof

      Footnotes

      Disclosure: The authors report no conflicts of interest.

      Founding: Norwegian South-Eastern Regional Health Authority

      Parts of the results were presented at 51st Annual Meeting of the International Continence Society, 14th to 17th October 2021, Online

      Condensation

      Pelvic floor symptoms differed from first pregnancy up to 8 years after delivery according to delivery mode. These differences were recognizable already prior to delivery.

      AJOG at a Glance

      The aim of this study was to describe urinary incontinence, vaginal symptoms, and bowel control symptoms from 21 weeks of gestation in the first pregnancy and up to 8 years after the first delivery, stratified by delivery mode.

      Already during pregnancy, women, who later delivered vaginally, had more and increasing pelvic floor symptoms compared to women who later delivered with cesarean. After delivery, women with cesarean delivery had lower symptom scores than women with vaginal delivery, however symptoms scores increased at 8-year follow-up in all delivery groups. Symptom scores were generally low in the entire population.

      The differences in pelvic floor symptoms prior to delivery highlights the need of considering antenatal data, when assessing pelvic floor symptoms according to delivery mode.

      Identification

      DOI: https://doi.org/10.1016/j.ajog.2022.06.020

      Copyright

      © 2022 Published by Elsevier Inc.

      ScienceDirect

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