Advertisement

Impact of mode of delivery of twins on the pelvic floor 3 and 12 months post-partum—part II

  • Fanny Béchard
  • Christel Castelli
  • Sandrine Alonso
  • Emmanuelle Vintejoux
  • François Goffinet
  • Vincent Letouzey
  • Thomas Schmitz
  • Renaud de Tayrac
Original Article

Abstract

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

Pelvic floor dysfunction Pelvic organ prolapse Twin pregnancy Postpartum Risk factors Vaginal delivery 

Notes

Funding

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

None.

References

  1. 1.
    Hadi E, Groutz A, Gold R, Lessing J, Gordon D. [Pregnancy, labor and delivery: the pelvic floor injury]. Harefuah. 2004;143:525–9 548, 547.PubMedGoogle Scholar
  2. 2.
    Gyhagen M, Åkervall S, Milsom I. Clustering of pelvic floor disorders 20 years after one vaginal or one cesarean birth. Int Urogynecol J. 2015;26:1115–21.CrossRefGoogle Scholar
  3. 3.
    Yohay D, Weintraub AY, Mauer-Perry N, Peri C, Kafri R, Yohay Z, et al. Prevalence and trends of pelvic floor disorders in late pregnancy and after delivery in a cohort of Israeli women using the PFDI-20. Eur J Obstet Gynecol Reprod Biol. 2016;200:35–9.CrossRefGoogle Scholar
  4. 4.
    Hallock JL, Handa VL. The epidemiology of pelvic floor disorders and childbirth: an update. Obstet Gynecol Clin N Am. 2016;43(1):1–13.CrossRefGoogle Scholar
  5. 5.
    Blondel B, Macfarlane A, Gissler M, Breart G, Zeitlin J, PERISTAT Study Group. Preterm birth and multiple pregnancy in European countries participating in the PERISTAT project. BJOG Int J Obstet Gynaecol. 2006;113(5):528–35.CrossRefGoogle Scholar
  6. 6.
    Kulkarni AD, Jamieson DJ, Jones HW, Kissin DM, Gallo MF, Macaluso M, et al. Fertility treatments and multiple births in the United States. N Engl J Med. 2013;369(23):2218–25.CrossRefGoogle Scholar
  7. 7.
    Kubotani JS, Araujo Júnior E, Zanetti MRD, Passos JP, de Jármy Di Bella ZIK, Júnior JE. Assessing the impact of twin pregnancies on the pelvic floor using 3-dimensional sonography: a pilot study. J Ultrasound Med. 2014;33(7):1179–83.CrossRefGoogle Scholar
  8. 8.
    Lanzarone V, Dietz HP. Three-dimensional ultrasound imaging of the levator hiatus in late pregnancy and associations with delivery outcomes. Aust N Z J Obstet Gynaecol. 2007;47(3):176–80.CrossRefGoogle Scholar
  9. 9.
    Schmitz T, Prunet C, Azria E, Bohec C, Bongain A, Chabanier P, et al. Association between planned cesarean delivery and neonatal mortality and morbidity in twin pregnancies. Obstet Gynecol. 2017;129(6):986–95.CrossRefGoogle Scholar
  10. 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
  11. 11.
    Legendre G, Tassel J, Salomon L-J, Fauconnier A, Bader G. [Impact of twin gestation on the risk of postpartum stress incontinence]. Gynecol Obstet Fertil. 2010;38:238–43.CrossRefGoogle Scholar
  12. 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
  13. 13.
    El-Azab AS, Abd-Elsayed AA, Imam HMK. Patient reported and anatomical outcomes after surgery for pelvic organ prolapse. Neurourol Urodyn. 2009;28(3):219–24.CrossRefGoogle Scholar
  14. 14.
    Fatton B, Letouzey V, Lagrange E, Mares P, Jacquetin B, de Tayrac R. [Validation of a French version of the short form of the pelvic organ prolapse/urinary incontinence sexual questionnaire (PISQ-12)]. J Gynecol Obstet Biol Reprod (Paris). 2009;38(8):662–7.CrossRefGoogle Scholar
  15. 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. 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
  17. 17.
    Sze EHM, Sherard GB, Dolezal JM. Pregnancy, labor, delivery, and pelvic organ prolapse. Obstet Gynecol. 2002;100(5 Pt 1):981–6.PubMedGoogle Scholar
  18. 18.
    Petrou S, Kim SW, McParland P, Boyle EM. Mode of delivery and long-term health-related quality-of-life outcomes: a prospective population-based study. Birth. 2017;44(2):110–9.CrossRefGoogle Scholar
  19. 19.
    Sadat Z, Taebi M, Saberi F, Kalarhoudi MA. The relationship between mode of delivery and postpartum physical and mental health related quality of life. Iran J Nurs Midwifery Res. 2013;18(6):499–504.PubMedPubMedCentralGoogle Scholar
  20. 20.
    Gholitabar M, Ullman R, James D, Griffiths M, Guideline Development Group of the National Institute for Health and Clinical Excellence. Caesarean section: summary of updated NICE guidance. BMJ. 2011;343:d7108.CrossRefGoogle Scholar

Copyright information

© The International Urogynecological Association 2018

Authors and Affiliations

  • Fanny Béchard
    • 1
  • Christel Castelli
    • 2
  • Sandrine Alonso
    • 2
  • Emmanuelle Vintejoux
    • 3
  • François Goffinet
    • 4
  • Vincent Letouzey
    • 1
  • Thomas Schmitz
    • 5
  • Renaud de Tayrac
    • 1
  1. 1.Department of Obstetrics and GynecologyCarémeau University HospitalNîmesFrance
  2. 2.Department of Biostatistics, Epidemiology, Public Health, and Medical Information (BESPIM)Nîmes University HospitalNîmesFrance
  3. 3.Department of Obstetrics and GynecologyArnaud de Villeneuve University HospitalMontpellierFrance
  4. 4.INSERM UMR 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), DHU Risks in PregnancyParis Descartes UniversityParisFrance
  5. 5.Department of Obstetrics and GynecologyRobert Debré University HospitalParisFrance

Personalised recommendations