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Association between vaginal or cesarean delivery and later development of stress urinary incontinence or pelvic organ prolapse: A retrospective population-based cohort study

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Abstract

Introduction and hypothesis

Child delivery mode may be associated with pelvic floor disorders. We explored the association between different delivery modes and later development of stress urinary incontinence (SUI) and pelvic organ prolapse (POP) in Taiwanese women.

Methods

This was a retrospective population-based cohort study. Women who delivered babies between January 1, 2000, and December 31, 2018, were selected for this study. The study used Taiwan’s National Health Insurance (NHI) Research Database. After propensity score matching, 51,587 women who underwent cesarean section (C/S) and 51,587 women who underwent vaginal delivery (VD) were recruited. Primary outcomes were the presence of SUI and POP after delivery.

Results

The incidence of SUI (1.6/1000 person-years) and POP (1.5/1000 person-years) was higher in the VD group than in the C/S group (0.8 and 0.6 in 1000 person-years). VD was associated with an increased risk of SUI [hazard ratio (HR): 2.79, 95% confidence interval (CI): 2.45–3.17] and POP (HR: 1.96, 95% CI: 1.75–2.19) compared to C/S. We also found that age (HR: 1.06, 95% CI: 1.05–1.08 in SUI, HR: 1.08, 95% CI: 1.07–1.09 in POP) and Charlson Comorbidity Index (CCI) (HR: 1.28, 95% CI: 1.12–1.46 in SUI, HR: 1.27, 95% CI: 1.13–1.43 in POP) were associated with an increased risk of SUI and POP. The cumulative incidence of SUI and POP was higher in the VD group than in the C/S group (log-rank test, P < 0.05).

Conclusions

The current study was the largest retrospective cohort study regarding the influence of delivery mode on SUI and POP so far. VD was found to be associated with an increased risk of SUI and POP compared with C/S. Postpartum care for pelvic physical therapy should be provided particularly to women undergoing VD.

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Data Availability

The dataset is not available for public access but is available from the Taiwan National Health Insurance Department upon reasonable request from the corresponding author.

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Acknowledgements

The authors would also like to thank the Tzu Chi University Research Center for Big Data Teaching, Research, and Statistical Consultation for providing statistical consultation assistance.

Funding

This study was supported by Hualien Tzu Chi Hospital (Industry-University Cooperation).

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, Hualien, 970, Taiwan

    Wing Lam Tsui & Dah-Ching Ding

  2. Tzu Chi University Research Center for Big Data Teaching, Research and Statistic Consultation, Tzu Chi University, Hualien, 970, Taiwan

    Guang-Hong Deng & Tsung-Cheng Hsieh

  3. Institute of Medical Sciences, Tzu Chi University, Hualien, 970, Taiwan

    Tsung-Cheng Hsieh & Dah-Ching Ding

Authors
  1. Wing Lam Tsui
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Contributions

Conceptualization and methodology, D.C.D.; formal analysis, investigation, and data curation, G.H.D. Writing – Original Draft Preparation, G.H.D. W.L.T., T.C.H., and D.C.D.; Writing – Review and Editing, W.L.T., G.H.D., and D.C.D. Supervision, Project Administration, and Funding Acquisition, D.C.D.

Corresponding author

Correspondence to Dah-Ching Ding.

Ethics declarations

Informed Consent

The requirement for informed consent was waived due to the low risk of patient safety and was approved by the committee.

Institutional Review Board

The Research Ethics Committee at Hualien Tzu Chi Hospital approved the use of NHRI-provided data for this study (institutional review board permit number: IRB111-043-C).

Conflicts of Interest

None.

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Tsui, W.L., Deng, GH., Hsieh, TC. et al. Association between vaginal or cesarean delivery and later development of stress urinary incontinence or pelvic organ prolapse: A retrospective population-based cohort study. Int Urogynecol J 34, 2041–2047 (2023). https://doi.org/10.1007/s00192-023-05504-6

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  • DOI: https://doi.org/10.1007/s00192-023-05504-6

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