Polina Schwarzman1,2, Dorit Paz Levy3, Asnat Walfisch4, Ruslan Sergienko5, Eli H Bernstein6, Eyal Sheiner3. 1. Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Yitzhak Rager Boulevard, 84105, Be'er Sheva, Israel. schwarzmanp@gmail.com. 2. , Be'er Sheva, Israel. schwarzmanp@gmail.com. 3. Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Yitzhak Rager Boulevard, 84105, Be'er Sheva, Israel. 4. Department of Obstetrics and Gynecology, Hadassah Mount Scopus Medical Center, Jerusalem, Israel. 5. Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel. 6. The Medical School for International Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
Abstract
INTRODUCTION AND HYPOTHESIS: Identifying protective factors against pelvic floor disorders (PFDs) is important. We investigated whether cesarean delivery (CD) at the indication of abnormal second stage of labor (ASSL) has the same protective effect against future PFDs. METHODS: This population-based cohort study included deliveries occurring from 1991-2017 in a tertiary medical center. Women were grouped by their delivery mode: patients with vaginal deliveries (VD) only; those with CD only, excluding second-stage indications; and those with CD due to ASSL. The outcome measure, PFDs and related repair diagnoses, included any recorded hospitalization involving a pre-defined set of ICD-9 codes. A Kaplan-Meier survival curve compared cumulative PFD morbidity in the different groups, and a Cox proportional hazards model controlled for confounders. RESULTS: A total of 106,003 patients met the inclusion criteria; 86.7% (n = 91,856) experienced VD only, 11.7% (n = 12,359) underwent CD only and 1.7% (n = 1788) had at least one CD due to ASSL. PFD-related hospitalization incidence was 0.7% (n = 719) for the entire cohort. While a significantly higher PFD-related hospitalization rate was recorded in the VD group (0.7%) compared with the ASSL CD group (0.3%) and the non-ASSL CD group (0.5%, p < 0.001), after controlling for potential confounders, an independent and protective association was noted between CD and later PFDs only in parturients who did not experience ASSL (aHR 0.679, 95% CI 0.51-0.90, p = 0.006). CONCLUSIONS: CDs may be protective against later PFD development only if performed prior to the second stage of labor.
INTRODUCTION AND HYPOTHESIS: Identifying protective factors against pelvic floor disorders (PFDs) is important. We investigated whether cesarean delivery (CD) at the indication of abnormal second stage of labor (ASSL) has the same protective effect against future PFDs. METHODS: This population-based cohort study included deliveries occurring from 1991-2017 in a tertiary medical center. Women were grouped by their delivery mode: patients with vaginal deliveries (VD) only; those with CD only, excluding second-stage indications; and those with CD due to ASSL. The outcome measure, PFDs and related repair diagnoses, included any recorded hospitalization involving a pre-defined set of ICD-9 codes. A Kaplan-Meier survival curve compared cumulative PFD morbidity in the different groups, and a Cox proportional hazards model controlled for confounders. RESULTS: A total of 106,003 patients met the inclusion criteria; 86.7% (n = 91,856) experienced VD only, 11.7% (n = 12,359) underwent CD only and 1.7% (n = 1788) had at least one CD due to ASSL. PFD-related hospitalization incidence was 0.7% (n = 719) for the entire cohort. While a significantly higher PFD-related hospitalization rate was recorded in the VD group (0.7%) compared with the ASSL CD group (0.3%) and the non-ASSL CD group (0.5%, p < 0.001), after controlling for potential confounders, an independent and protective association was noted between CD and later PFDs only in parturients who did not experience ASSL (aHR 0.679, 95% CI 0.51-0.90, p = 0.006). CONCLUSIONS: CDs may be protective against later PFD development only if performed prior to the second stage of labor.
Entities:
Keywords:
Cesarean delivery; Pelvic floor dysorders; Prolonged second stage of labor; Risk factors; Vaginal delivery
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