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Pelvic floor dysfunction after vaginal delivery: MOODS—a prospective study

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Abstract

Introduction and hypothesis

Labor is a known risk factor for pelvic floor dysfunction (PFD); however, the impact of operative vaginal delivery (OVD), particularly spatulas, remains unclear. The aim of this study was to compare postpartum PFD symptoms in women undergoing spontaneous vaginal delivery (SVD) and those undergoing OVD.

Methods

An observational prospective study (MOODS: Maternal-neonatal Outcomes in Operative Vaginal Delivery) was enrolled at Hospital de Braga from February to October 2018. All singleton term OVD (Thierry spatulas and vacuum extractor) and a convenience SVD sample were recruited, in a 2:1 ratio. To assess PFD symptoms Pelvic Floor Distress Inventory-20 (PFDI-20) was applied at 3, 6, and 12 months postpartum. The questionnaire is divided into three subscales: Urinary (UDI), Colorectal-Anal (CRADI), and Pelvic Organ Prolapse Distress Inventory (POPDI).

Results

Of the 304 women recruited, 207 were included, 34.3% with SVD and 65.7% with OVD. Thierry spatulas were used in 53.7% of women undergoing OVD. Frequency of nulliparous (p < 0.001), episiotomy (p < 0.001), neuraxial anesthesia (p < 0.001), postpartum pain (p = 0.001) and occiput-posterior fetal position (p < 0.001) were significantly higher in OVD. Second phase of labor duration was longer in OVD (p = 0.001). At 3 months postpartum, women undergoing OVD and spatula-assisted delivery had higher UDI score, POPDI score, and global score, with no differences at 6 months and 1 year. After controlling for confounding variables, OVD and spatulas were still associated with greater POPDI scores at 3 months postpartum.

Conclusions

Operative vaginal delivery, particularly with spatulas, seems to be associated with a higher prevalence of early PFD symptoms, mainly regarding pelvic organ prolapse.

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Acknowledgements

The authors wish to acknowledge the support of several clinicians and midwives from the Department of Obstetrics and Gynecology of the Hospital de Braga for their help with patient recruitment, and to all the participants for their contribution.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Hospital de Braga, Sete Fontes - São Victor, 4710-243, Braga, Portugal

    Ana Catarina Borges, Natacha Sousa, Rita Sarabando, Catarina Vieira, Bárbara Ribeiro, Paulina Barbosa, Alexandra Miranda, Isabel Reis & Cristina Nogueira-Silva

  2. Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal

    Alexandra Miranda & Cristina Nogueira-Silva

  3. ICVS/3B’s—PT Government Associate Laboratory, Braga/Guimarães, Portugal

    Alexandra Miranda & Cristina Nogueira-Silva

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  1. Ana Catarina Borges
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Correspondence to Ana Catarina Borges.

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Borges, A.C., Sousa, N., Sarabando, R. et al. Pelvic floor dysfunction after vaginal delivery: MOODS—a prospective study. Int Urogynecol J 33, 1539–1547 (2022). https://doi.org/10.1007/s00192-021-04982-w

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