Fanny Béchard1, Christel Castelli2, Sandrine Alonso2, Emmanuelle Vintejoux3, François Goffinet4, Vincent Letouzey1, Thomas Schmitz5, Renaud de Tayrac6. 1. Department of Obstetrics and Gynecology, Carémeau University Hospital, Nîmes, France. 2. Department of Biostatistics, Epidemiology, Public Health, and Medical Information (BESPIM), Nîmes University Hospital, Nîmes, France. 3. Department of Obstetrics and Gynecology, Arnaud de Villeneuve University Hospital, Montpellier, France. 4. INSERM UMR 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), DHU Risks in Pregnancy, Paris Descartes University, Paris, France. 5. Department of Obstetrics and Gynecology, Robert Debré University Hospital, Paris, France. 6. Department of Obstetrics and Gynecology, Carémeau University Hospital, Nîmes, France. renaud.detayrac@chu-nimes.fr.
Abstract
INTRODUCTION AND HYPOTHESIS: To compare the impact of vaginal delivery (VD) versus cesarean section (CS) on the pelvic floor in twin primiparae at 3 and 12 months postpartum. METHODS: This comparative multicenter prospective cohort from a large French national cohort study consisted of primiparas who gave birth to live twins after 34 weeks of gestation. The primary end point was the postnatal urinary incontinence rate 3 months postpartum. The secondary end points were the pelvic floor dysfunction (PFD) at 3 and 12 months based on PFDI-20, PFIQ-7, PISQ-12, and SF-12 responses. RESULTS: A total of 2812 patients in 172 French maternity units were recruited between February 2014 and March 2015: 1076 (38%) responded at 3 and 12 months (61% at 3 months); 1155 were analyzed at 3 months (556 VD and 599 CS) and 800 at 12 months (394 VD and 406 CS). VD was associated with more symptoms at 3 months [median PFDI-20 score 25/300 (8-50) vs. 17/300 (4-36) after CS; p < 0.0001]. Vaginal bulge was more frequently reported after VD (9 vs. 4%; p = 0.0015). Abdnormal PFD-related quality-of-life scores (scores > 0) were more frequent after VD at 3 months (58 vs. 42%; p < 0.0001) and 12 months (57 vs. 43%; p = 0.0020), indicating greater discomfort. However, SF-12 scores were higher after VD [56 (53-59) vs. 55 (51-58)] at 12 months, indicating better general quality of life. CONCLUSIONS: Mode of delivery is significantly associated with pelvic organ prolapse symptoms 3 months postpartum, which regress by 12 months, probably because of the known spontaneous postnatal improvement of PFDs.
INTRODUCTION AND HYPOTHESIS: To compare the impact of vaginal delivery (VD) versus cesarean section (CS) on the pelvic floor in twin primiparae at 3 and 12 months postpartum. METHODS: This comparative multicenter prospective cohort from a large French national cohort study consisted of primiparas who gave birth to live twins after 34 weeks of gestation. The primary end point was the postnatal urinary incontinence rate 3 months postpartum. The secondary end points were the pelvic floor dysfunction (PFD) at 3 and 12 months based on PFDI-20, PFIQ-7, PISQ-12, and SF-12 responses. RESULTS: A total of 2812 patients in 172 French maternity units were recruited between February 2014 and March 2015: 1076 (38%) responded at 3 and 12 months (61% at 3 months); 1155 were analyzed at 3 months (556 VD and 599 CS) and 800 at 12 months (394 VD and 406 CS). VD was associated with more symptoms at 3 months [median PFDI-20 score 25/300 (8-50) vs. 17/300 (4-36) after CS; p < 0.0001]. Vaginal bulge was more frequently reported after VD (9 vs. 4%; p = 0.0015). Abdnormal PFD-related quality-of-life scores (scores > 0) were more frequent after VD at 3 months (58 vs. 42%; p < 0.0001) and 12 months (57 vs. 43%; p = 0.0020), indicating greater discomfort. However, SF-12 scores were higher after VD [56 (53-59) vs. 55 (51-58)] at 12 months, indicating better general quality of life. CONCLUSIONS: Mode of delivery is significantly associated with pelvic organ prolapse symptoms 3 months postpartum, which regress by 12 months, probably because of the known spontaneous postnatal improvement of PFDs.
Authors: Aniket D Kulkarni; Denise J Jamieson; Howard W Jones; Dmitry M Kissin; Maria F Gallo; Maurizio Macaluso; Eli Y Adashi Journal: N Engl J Med Date: 2013-12-05 Impact factor: 91.245
Authors: Barbara Bodner-Adler; Oliver Kimberger; Thomas Laml; Ksenia Halpern; Clara Beitl; Wolfgang Umek; Klaus Bodner Journal: Arch Gynecol Obstet Date: 2019-10-10 Impact factor: 2.344