Document Type : Original Article
Authors
- Maryam Hajihashemy 1
- Shadi Zamansaraei 1
- Abbasali Pourmomeni 2
- Vida Sarmadi 3
- Mahtab Ebrahim Babaei 1
1 Department of Obstetrics and Gynecology Surgery, Isfahan University of Medical Sciences, Isfahan, Iran
2 Pelvic Floor Research Center, School of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
3 School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
Background: Pelvic floor disorders include urinary incontinence, fecal incontinence, pelvic visceral prolapse, and sexual dysfunction, which are more common in women after childbirth. In the present study, we aimed to investigate and compare pelvic floor disorders in primiparous women 2 and 6 months after vaginal delivery and cesarean section by using a questionnaire, clinical examination, and perineometer at the same time.
Methods: This Prospective cohort study was performed on 76 primiparous mothers under normal delivery and cesarean section. All participants were examined after 2 to 6 months after delivery by perineometer pelvic organ prolapse quantification test (POPQ), pelvic floor distress questionnaire (PFDI-20), and female sexual function index (FSFI).
Results: The mean of perineometer power and FSFI in the cesarean section group was significantly higher than in the vaginal delivery group (P<0.001). Otherwise, the mean of Anterior and posterior wall prolapse severity and mean of PFDI in the vaginal delivery group were significantly higher than cesarean section patients (P<0.05 and <0.001, respectively).
Conclusion: Although the symptoms of pelvic floor muscle weakness, pelvic floor disorder, and the severity of prolapse in the vaginal delivery group was greater than the cesarean section, the improvement in sexual function and prolapse symptoms over time in the vaginal delivery group and obtaining the same
results in questionnaires after 6 months, shows that most of these symptoms are temporary in the women who had an uncomplicated vaginal delivery, and passing of time, environmental factors and lifestyle are effective in improving most of the pelvic symptoms after delivery.
Keywords
- Nygaard I, Barber MD, Burgio KL, Kenton K, Meikle S, Schaffer J, et al. Prevalence of symptomatic pelvic floor disorders in US women. Jama. 2008;300(11):1311-6. doi: 10.1001/jama.300.11.1311.
- Akhlaghi F. The prevalence of pelvic floor disorders in women that referred to the clinic of gynecology in Zeinab hospital, Mashhad, Iran, 2003. 2004. doi: 10.1016/j.ajog.2017.11.604
- Sung VW, Washington B, Raker CA. Costs of ambulatory care related to female pelvic floor disorders in the United States. American journal of obstetrics and gynecology. 2010;202(5):483. e1-. e4. doi: 10.1016/j.ajog.2010.01.015
- Fornell EU, Wingren G, KjØlhede P. Factors associated with pelvic floor dysfunction with emphasis on urinary and fecal incontinence and genital prolapse: an epidemiological study. Acta obstetricia et gynecologica Scandinavica. 2004;83(4):383-9. doi: 10.1080/j.0001-6349.2004.00367.x
- Gyhagen M, Åkervall S, Milsom I. Clustering of pelvic floor disorders 20 years after one vaginal or one cesarean birth. International urogynecology journal. 2015;26(8):1115-21. doi: 10.1007/s00192-015-2663-3. doi: 10.1007/s00192-015-2663-3
- Azami-Aghdash S, Ghojazadeh M, Dehdilani N, Mohammadi M. Prevalence and causes of cesarean section in Iran: systematic review and meta-analysis. Iranian journal of public health. 2014;43(5):545. PMID: 26060756; PMCID: PMC4449402.
- Faisal I, Matinnia N, Hejar A, Khodakarami Z. Why do primigravidae request caesarean section in a normal pregnancy? A qualitative study in Iran. Midwifery. 2014;30(2):227-33. doi: 10.1016/j.midw.2013.08.011
- MacArthur C, Wilson D, Herbison P, Lancashire R, Hagen S, Toozs‐Hobson P, et al. Urinary incontinence persisting after childbirth: extent, delivery history, and effects in a 12–year longitudinal cohort study. BJOG: An International Journal of Obstetrics & Gynaecology. 2016;123(6):1022-9. doi: 10.1111/1471-0528.13395
- Persu C, Chapple C, Cauni V, Gutue S, Geavlete P. Pelvic Organ Prolapse Quantification System (POP–Q)–a new era in pelvic prolapse staging. Journal of medicine and life. 2011;4(1):75. PMID: 21505577; PMCID: PMC3056425
- Weber A, Abrams P, Brubaker L, Cundiff G, Davis G, Dmochowski R, et al. The standardization of terminology for researchers in female pelvic floor disorders. International urogynecology journal. 2001;12(3):178-86. doi: https://doi.org/10.1007/PL00004033
- Pourmomeny A, Alebouyeh S, Torkzadeh A. Quantitative and Qualitative Tools in Studies on Pelvic Floor Muscle Rehabilitation. Journal of Research in Rehabilitation Sciences. 2017;12(5):306-17. doi: 10.1016/j.clinbiomech.2016.11.003. PMID: 27886590.
- Hakimi S, Hajebrahimi S, Bastani P, Aminian E, Ghana S, Mohammadi M. 208: translation and validation of the pelvic floor distress inventory short form (PFDI-20), Iranian version. BMJ open. 2017;7(Suppl 1):bmjopen-2016-015415.208. doi: 10.1136/bmjopen-2016-015415.208
- Rosen CB, J. Heiman, S. Leiblum, C. Meston, R. Shabsigh, D. Ferguson, R. D'Agostino, R. The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. Journal of sex & marital therapy. 2000;26(2):191-208. doi: 10.1080/009262300278597. PMID: 10782451.
- Mohammadi K, HEYDARI M, Faghihzadeh S. The female sexual function index (FSFI): validation of the Iranian version. 2008. doi:10.1186/s12905-019-0755-9. PMID: 31039769.
- Afshari P, Dabagh F, Iravani M, Abedi P. Comparison of pelvic floor muscle strength in nulliparous women and those with normal vaginal delivery and cesarean section. International urogynecology journal. 2017;28(8):1171-5. doi: 10.1007/s00192-016-3239-6
- Kokabi R, Yazdanpanah D. Effects of delivery mode and sociodemographic factors on postpartum stress urinary incontinency in primipara women: A prospective cohort study. Journal of the Chinese Medical Association. 2017;80(8):498-502. doi: 10.1016/j.jcma.2016.06.008
- Noor R, Neelam H, Bashir MS. Mode of delivery and pelvic floor disorder. Rawal Medical Journal. 2017;42(4):503-6. doi: 10.1016/j.tjog.2014.08.001. PMID: 25510682.
- Basirat Z, Bakhtiari A, Payandeh P. Postpartum stress urinary incontinence and some related factors. Journal of Babol University of Medical Sciences. 2008;10(5):41-7. doi: 10.1016/j.ejogrb.2019.10.020
- El-Sayed HAE, Ramadan S, Ibrahim H, Moursi HAA. The effect of mode of delivery on postpartum sexual function and sexual quality of life in primiparous women. American Journal of Nursing Science. 2017;6(4):347-57. doi: 10.11648/j.ajns.20170604.19
- Khajehei M, Ziyadlou S, Safari RM, Tabatabaee H, Kashefi F. A comparison of sexual outcomes in primiparous women experiencing vaginal and caesarean births. Indian journal of community medicine: official publication of Indian Association of Preventive & Social Medicine. 2009;34(2):126. doi: 10.4103/0970-0218.51237. PMCID: PMC2781119. PMID: 19966959
- Amiri FN, Omidvar S, Bakhtiari A, Hajiahmadi M. Female sexual outcomes in primiparous women after vaginal delivery and cesarean section. African health sciences. 2017;17(3):623-31. doi: 10.4314/ahs.v17i3.4
- Song M, Ishii H, Toda M, Tomimatsu T, Katsuyama H, Nakamura T, et al. Association between sexual health and delivery mode. Sexual medicine. 2014;2(4):153-8. doi: 10.1002/sm2.46. PMID: 25548646. PMCID: PMC4272246
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