OBJECTIVES: Study possible associations between mode of delivery and pelvic organ prolapse (POP) and pelvic floor muscle trauma 16-24 years after first delivery and in particular study differences between forceps and vacuum deliveries.
METHODS: Cross-sectional study including 608 women who delivered their first child in 1990-97, examined with POP quantification and pelvic floor ultrasound in 2013-14. Outcome measures were POP stage ≥ 2 or previous prolapse surgery, levator avulsion and levator hiatal area at Valsalva.
RESULTS: Comparing forceps to vacuum delivery the adjusted odds ratio (aOR) for POP≥ stage 2 or surgery was 1.72 (95% CI 1.06, 2.79), levator avulsion 4.16 (95% CI 2.28, 7.59) and hiatal areas were larger with adjusted mean difference (aMD) 4.75 cm2 (95% CI 2.46, 7.03). Comparing forceps to normal vaginal delivery aOR for POP≥ stage 2 or surgery was 1.74 (95% CI 1.12, 2.68), levator avulsion 4.35 (95% CI 2.56, 7.40) and hiatal areas were larger, aMD 3.84 cm2 (95% CI 1.78, 5.90). There were no differences between vacuum and normal vaginal delivery. Comparing Cesarean delivery to normal vaginal delivery aOR for POP≥ stage 2 or surgery was 0.06 (95% CI 0.02, 0.14), cOR for levator avulsion was 0.00 (95% CI 0.00, 0.30) and hiatal areas were smaller, aMD -8.35 cm2 (95% CI -10.87, -5.84).
CONCLUSIONS: POP≥ stage 2 or surgery, levator avulsion and hiatal area were associated with delivery mode. Cesarean delivery had decreased risk and vacuum had similar risk compared to normal vaginal delivery. Forceps had increased risk compared to vacuum and normal vaginal delivery.
Volløyhaug I, Mørkved S, Salvesen Ø, Salvesen KÅ. Are you the author?
Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway; Department of Obstetrics and Gynecology, Trondheim University Hospital, Norway.
Reference: Ultrasound Obstet Gynecol. 2015 Apr 29. Epub ahead of print.