Vaginal Birth After C-Section Tied to Later Pelvic Floor Surgery

Among women with a previous cesarean section, giving birth via a subsequent planned vaginal birth is associated with an increased risk for undergoing later pelvic floor surgery, according to a study published online Nov. 22 in PLOS Medicine.

Kathryn E. Fitzpatrick, from the University of Oxford in the United Kingdom, and colleagues examined the association between planned mode of birth after previous cesarean section and the woman’s subsequent risk for undergoing pelvic floor surgery. The analysis included data from 47,414 singleton term births in Scotland between 1983 and 1996 to women with one or more previous cesarean sections followed for a median 22.1 years.

The researchers found that the crude incidence rate of any pelvic floor surgery was 1.35 per 1,000 person-years in the overall study population, 1.75 in the planned vaginal birth after previous cesarean (VBAC) group, and 0.66 in the elective repeat cesarean section (ERCS) group. Compared with ERCS, planned VBAC was associated with an increased risk for the woman undergoing any pelvic floor surgery (adjusted hazard ratio, 2.38) and an increased risk for having surgery for pelvic organ prolapse or urinary incontinence (adjusted hazard ratios, 3.17 and 2.26, respectively). An analysis by actual mode of birth showed these increased risks were only apparent in the women who actually had a VBAC, while women who needed an in-labor nonelective repeat cesarean section had a similar risk for pelvic floor surgery to those who had an ERCS.

“These risks appear to be only apparent in women who actually give birth vaginally as planned, highlighting the role of vaginal birth rather than labor in pelvic floor dysfunction requiring surgery,” the authors write.

Two authors disclosed financial ties to the pharmaceutical and medical technology industries.

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