Pelvic floor trauma after childbirth - Risk factors, surgical treatment and prevention

Abstract

Background: As women live longer, the long-term effects of childbirth may negatively affect their quality of life and professional careers. Aim: The overall objective of this thesis was to examine how childbirth-related factors, such as delivery mode, number of births, and infant birth weight, affect long-term pelvic floor health in mothers, with a focus on the risks of pelvic floor disorders, surgical interventions, and the prevention of obstetric anal sphincter injury (OASI). Material and methods: Papers I and II analysed cohorts of women from the Swedish National Quality Register of Gynecological Surgery who underwent prolapse or incontinence surgery. National birth registers were used in Papers I, III, and IV to identify women with a first and second vaginal delivery. Results: In Paper I, pregnancies per se were not associated with an increased risk of surgery for pelvic organ prolapse or urinary incontinence compared with nulliparous women. Vaginal delivery increased the risk of surgery for pelvic organ prolapse or urinary incontinence, while cesarean delivery alone preserved long-term pelvic floor support, similar to that of nulliparous women. Paper II: Despite lower cure rates with increasing age and morbidity, most women were satisfied with mid-urethral sling surgery if incontinence episodes decreased. Women with severe incontinence were more likely to improve and report satisfaction. In Paper III, higher infant birthweight reduced the rate of spontaneous vaginal delivery (80.4% to 44.9%) and increased acute cesarean rates (8.3% to 41.6%). Delivery experience declined with higher birthweight, mirroring complication patterns. In Paper IV, incorporating infant biometrics and intrapartum factors improved OASI risk prediction and informed clinical decision-making through an online calculator. Conclusion: Vaginal delivery increases pelvic floor surgery risk, whereas cesarean delivery is protective. Despite lower cure rates with age and morbidity, most women were satisfied with sling surgery if incontinence symptoms improved. Accurate infant birthweight assessment is crucial for preventing birth trauma and enabling personalised obstetric care.