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<h5 class="section-title" id="d9651273e261">Question</h5>
<p id="d9651273e263">Is childbirth delivery mode associated with risk of pelvic floor
disorders over time?</p>
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<h5 class="section-title" id="d9651273e266">Findings</h5>
<p id="d9651273e268">In this cohort study of 1528 women, compared with spontaneous
vaginal delivery, cesarean
delivery was associated with a significantly lower risk of stress urinary incontinence
(adjusted hazard ratio [aHR], 0.46), overactive bladder (aHR, 0.51), and pelvic organ
prolapse (aHR, 0.28); operative vaginal delivery was associated with a significantly
higher risk of anal incontinence (aHR, 1.75) and pelvic organ prolapse (aHR, 1.88).
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<h5 class="section-title" id="d9651273e271">Meaning</h5>
<p id="d9651273e273">After childbirth, the risk of pelvic floor disorders varied by
delivery mode.</p>
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<h5 class="section-title" id="d9651273e277">Importance</h5>
<p id="d9651273e279">Pelvic floor disorders (eg, urinary incontinence), which affect
approximately 25%
of women in the United States, are associated with childbirth. However, little is
known about the course and progression of pelvic floor disorders over time.
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<h5 class="section-title" id="d9651273e282">Objective</h5>
<p id="d9651273e284">To describe the incidence of pelvic floor disorders after childbirth
and identify
maternal and obstetrical characteristics associated with patterns of incidence 1 to
2 decades after delivery.
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<h5 class="section-title" id="d9651273e287">Design, Setting, and Participants</h5>
<p id="d9651273e289">Women were recruited from a community hospital for this cohort
study 5 to 10 years
after their first delivery and followed up annually for up to 9 years. Recruitment
was based on mode of delivery; delivery groups were matched for age and years since
first delivery. Of 4072 eligible women, 1528 enrolled between October 2008 and December
2013. Annual follow-up continued through April 2017.
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<h5 class="section-title" id="d9651273e292">Exposures</h5>
<p id="d9651273e294">Participants were categorized into the following mode of delivery
groups: cesarean
birth (cesarean deliveries only), spontaneous vaginal birth (≥1 spontaneous vaginal
delivery and no operative vaginal deliveries), or operative vaginal birth (≥1 operative
vaginal delivery).
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<h5 class="section-title" id="d9651273e297">Main Outcomes and Measures</h5>
<p id="d9651273e299">Stress urinary incontinence (SUI), overactive bladder (OAB),
and anal incontinence
(AI), defined using validated threshold scores from the Epidemiology of Prolapse and
Incontinence Questionnaire, and pelvic organ prolapse (POP), measured using the Pelvic
Organ Prolapse Quantification Examination. Cumulative incidences, by delivery group,
were estimated using parametric methods. Hazard ratios, by exposure, were estimated
using semiparametric models.
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<h5 class="section-title" id="d9651273e302">Results</h5>
<p id="d9651273e304">Among 1528 women (778 in the cesarean birth group, 565 in the
spontaneous vaginal
birth group, and 185 in the operative vaginal birth group), the median age at first
delivery was 30.6 years, 1092 women (72%) were multiparous at enrollment (2887 total
deliveries), and the median age at enrollment was 38.3 years. During a median follow-up
of 5.1 years (7804 person-visits), there were 138 cases of SUI, 117 cases of OAB,
168 cases of AI, and 153 cases of POP. For spontaneous vaginal delivery (reference),
the 15-year cumulative incidences of pelvic floor disorders after first delivery were
as follows: SUI, 34.3% (95% CI, 29.9%-38.6%); OAB, 21.8% (95% CI, 17.8%-25.7%); AI,
30.6% (95% CI, 26.4%-34.9%), and POP, 30.0% (95% CI, 25.1%-34.9%). Compared with spontaneous
vaginal delivery, cesarean delivery was associated with significantly lower hazard
of SUI (adjusted hazard ratio [aHR], 0.46 [95% CI, 0.32-0.67]), OAB (aHR, 0.51 [95%
CI, 0.34-0.76]), and POP (aHR, 0.28 [95% CI, 0.19-0.42]), while operative vaginal
delivery was associated with significantly higher hazard of AI (aHR, 1.75 [95% CI,
1.14-2.68]) and POP (aHR, 1.88 [95% CI, 1.28-2.78]). Stratifying by delivery mode,
the hazard ratios for POP, relative to a genital hiatus size less than or equal to
2.5 cm, were 3.0 (95% CI, 1.7-5.3) for a genital hiatus size of 3 cm and 9.0 (95%
CI, 5.5-14.8) for a genital hiatus size greater than or equal to 3.5 cm.
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<h5 class="section-title" id="d9651273e307">Conclusions and Relevance</h5>
<p id="d9651273e309">Compared with spontaneous vaginal delivery, cesarean delivery
was associated with
significantly lower hazard for stress urinary incontinence, overactive bladder, and
pelvic organ prolapse, while operative vaginal delivery was associated with significantly
higher hazard of anal incontinence and pelvic organ prolapse. A larger genital hiatus
was associated with increased risk of pelvic organ prolapse independent of delivery
mode.
</p>
</div><p class="first" id="d9651273e312">This cohort study describes the incidence
of urinary incontinence, organ prolapse,
and other pelvic floor disorders among women who gave birth via cesarean, spontaneous
vaginal, or operative vaginal delivery.
</p>