Cesarean mode of delivery protects against pelvic organs prolapse and genitourinary surgeries

Sweden: There may be a decreased likelihood of pelvic organ prolapse and stress urinary incontinence operations in women who had cesarean deliveries, says an article published in the American Journal of Obstetrics & Gynecology.

Vaginal birth, parity, and pregnancy's long-term consequences on the pelvic floor are all hotly debated topics. Surgical registration data may provide a more reliable measure for assessing the relative effect of these risk variables than studies that rely on self-reported symptoms.

In order to determine how vaginal births, cesarean deliveries, parity, and factors unassociated with childbirth in nulliparous women influence the likelihood of reconstructive urogenital surgery in women aged 45 or older, Larsudd-Kverud and colleagues evaluated data from three national registers: the Swedish National Quality Register of Gynecological Surgery, the Swedish Medical Birth Register, and the Total Population Register.

The following groups were created by stratifying the participants: 1. virginity; 2. having given birth by vaginal delivery; and 3. giving birth via cesarean section. The 2,309,765 women who were born in 1960 and who were included in the Total Population Register were used as the reference group for the calculations of risk for each category.

The key findings of this study were as follows:

1. Prolapse surgery was performed on 39,617 women, and incontinence surgery on 20,488 women.

2. Women who underwent prolapse surgery had 97.8% vaginal births, 0.4% cesarean births, and 1.9% nulliparous.

3. 93.1%, 2.6%, and 4.3% were the corresponding figures for those who underwent incontinence surgery.

4. Women who gave birth vaginally were overrepresented in prolapse and incontinence surgery.

5. Women who had C-section births and neoplasia were underrepresented in prolapse surgery and incontinence surgery.

6. In comparison to vaginal birth, the AR of prolapse surgery was lowest following cesarean delivery.

7. Following vaginal deliveries, the AR for prolapse surgery grew steadily with parity. Similar to nulliparous women, this trend did not continue following cesarean birth.

8. The greatest increase in AR for POP surgery (x 6) and SUI surgery was associated with the first vaginal delivery (x3).

9. For POP surgery (1/3 of the first vaginal birth) and SUI surgery (1/10 of the first vaginal birth), the second vaginal birth contributed the lowest AR.

In conclusion, based on the findings of this study, researchers did not discover any more evidence that pregnancy alone, or the cumulative impact of many pregnancies, elevated the likelihood of surgery for POP or UI over that in nulliparous women. In the long run, it appeared that primarily having cesarean deliveries kept the pelvic floor support nulliparous. Therefore, the detrimental effects of vaginal birth may be partially attributed to the resources spent in healthcare for urogenital surgery. 

Reference: 

Larsudd-Kåverud, J., Gyhagen, J., Åkervall, S., Molin, M., Milsom, I., Wagg, A., & Gyhagen, M. (2022). The influence of pregnancy, parity, and mode of delivery on urinary incontinence and prolapse surgery – a national register study. In American Journal of Obstetrics and Gynecology. Elsevier BV. https://doi.org/10.1016/j.ajog.2022.07.035