Presentation Authors: Colby Souders*, Farnoosh Nik-Ahd, Ashley Caron, Karyn Eilber, Jennifer Anger, Los Angeles, CA
Introduction: Studies evaluating pelvic floor disorders associated with Cesarean section (CS) have varying results. These conflicting results may stem from confounding factors, namely grouping of elective and emergency CS data together, including multiparous and primiparous women in the same data set. We performed a systematic literature review to understand the pelvic floor outcomes for primiparous women who received a primary elective CS, emergency CS, or who delivered vaginally. Our hypothesis was that primary elective CS in primiparous women would be protective against pelvic floor disorders.
Methods: We used MOOSE Criteria and searched the PubMed and the Cochrane Review. We searched for articles that analyzed data on delivery methods among primiparous women. The following outcomes were evaluated: urinary incontinence (UI), fecal incontinence (FI), and pelvic organ prolapse (POP).
Results: Twenty studies met inclusion criteria for our analysis: fourteen evaluated urinary incontinence outcomes, eight evaluated fecal incontinence outcomes, and two evaluated pelvic organ prolapse. For UI, rates after elective CS ranged from 0-30.8%, emergency CS 0-50.0%, and vaginal birth (VB) 3.8-53.1%. Pooled analysis shows a prevalence of UI to be similar between elective CS and emergency CS (16%). Prevalence of UI in VB pooled analysis was approximately 30%. The odds ratio for developing UI after VB compared to any CS was 1.8 (95% CI 1.6-2.1; p-value < 0.0001). The range of FI after elective CS was 0-37.7%, emergency CS 0-37.5%, and VB 0-47.8%. Pooled analysis shows that the rate of FI is higher in emergency CS and VB. The OR of developing FI after VB is 1.3 (95% CI: 1.16 to 1.40 P-value < 0.0001) compared to any type of CS. Only two studies examined POP, both of which found a statistically significant protective effect of any type of CS in preventing POP.
Conclusions: Among primiparous women, CS may be protective against UI and FI. However, there is significant variability in the prevalence of UI and FI between the studies. There is a paucity of data regarding the effect of elective CS on POP among primiparous women.