Association Between Mode of Delivery and Pelvic Floor Dysfunction Symptoms

Background: Pelvic floor disorders (PFD) are highly prevalent, contributing to reduced quality of life. Despite numerous investigations demonstrating that vaginal delivery has a detrimental impact on the structures and functions of the pelvic floor, there is insufficient scientific evidence to recommend performing elective caesarean delivery to prevent the progression of PFD. Aim of the work: To compare PFD symptoms five years after the last delivery between women with history of vaginal vs. cesarean delivery. Patient and Methods: This cross-sectional study recruited 200 women aged 25-45 years with singleton gestation, divided into two groups: vaginal delivery group (n=81) and elective cesarean delivery group (n=119). The Pelvic Organ Prolapse Quantification (POPQ) system and the Australian Pelvic Floor Questionnaire (APFQ) were used to assess PFD among the studied cases. Result: Women with vaginal delivery had higher rates of prolapse according to POPQ system (63% vs. 48%, p=0.036) and higher scores of APFQ (12.31 ± 3.73 vs. 10.36 ± 2.8, p<0.0001). In terms of symptoms, the group that underwent vaginal delivery had a significantly higher prevalence of urinary incontinence (33.33%) compared to the cesarean section (CS) group (5.26%) (p = 0.0295) and pelvic pain (55.56%) compared to the CS group (21.05%) (p = 0.0308). Women with vaginal deliveries experienced a greater severity of pelvic floor dysfunction with an increase in the number of deliveries. Conclusion: Prolapse symptoms negatively correlate with cesarean sections but positively correlate with vaginal deliveries. Sexual function is not linked to cesarean sections but is positively associated with vaginal deliveries and related symptoms. Evaluation of pelvic floor should be emphasized in vaginal birth group.