Impact of mode of delivery of twins on the pelvic floor 3 and 12 months post-partum—part II
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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.
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.
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.
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.
KeywordsPelvic floor dysfunction Pelvic organ prolapse Twin pregnancy Postpartum Risk factors Vaginal delivery
This study was funded by the Nimes University Hospital (AOI GCS Merri Nîmes-Montpellier).
Compliance with ethical standards
Details of ethics approval
This study was approved by the Comité consultatif sur le traitement de l’information en matière de recherche dans le domaine de la santé and by the Commission Nationale de l’Informatique et des Libertés (autorization no. 913448).
The study was recorded on Clinicaltrials.gov at no. NCT02059746.
Conflicts of interest
- 10.Blondel B, Gonzales L, Raynaud P. French National Perinatal Survey 2016. INSEM and DREES. http://www.epopé-inserm.fr/wp-content/uploads/2017/10/ENP2016_rapport_complet.pdf [French].Google Scholar
- 12.de Tayrac R, Deval B, Fernandez H, Marès P, Mapi Research Institute. [Development of a linguistically validated French version of two short-form, condition-specific quality of life questionnaires for women with pelvic floor disorders (PFDI-20 and PFIQ-7)]. J Gynecol Obstet Biol Reprod (Paris). 2007;36(8):738–48.CrossRefGoogle Scholar
- 15.Kosinski M, Ware JE, Turner-Bowker DM, Gandek B. User’s manual for the SF-12v2 health survey: with a supplement documenting the SF-12® health survey. QualityMetric incorporated: Lincoln; 2007.Google Scholar
- 16.Hutton EK, Hannah ME, Ross S, Joseph KS, Ohlsson A, Asztalos EV, et al. Maternal outcomes at 3 months after planned caesarean section versus planned vaginal birth for twin pregnancies in the twin birth study: a randomised controlled trial. BJOG Int J Obstet Gynaecol. 2015;122(12):1653–62.CrossRefGoogle Scholar