PREVALENCE AND PREDICTORS OF PELVIC FLOOR DYSFUNCTION AMONG POSTPARTUM WOMEN FOLLOWING INSTRUMENTAL VS SPONTANEOUS VAGINAL DELIVERY

Abstract

Background: Pelvic floor dysfunction is a common postpartum condition which can lead to urinary incontinence, anal incontinence, prolapse of the pelvic organs, pelvic pain and sexual problems. This study was performed to estimate its prevalence and predictors in women who had instrumental vaginal delivery (IVD) versus spontaneous vaginal delivery (SVD) after delivery at Hayatabad Medical Complex, Peshawar.

Method: The design was comparative analytical cross sectional in hospital. The sample consisted of 340 postpartum women who were examined 6-12 weeks after delivery, of which 170 women experienced instrumental VD and 170 women experienced spontaneous VD. The Pelvic Floor Distress Inventory-20 (PFDI-20) was used to assess pelvic floor symptoms. Descriptive statistics, chi square tests, bivariate logistic regression and multivariable binary logistic regression were used to analyses the data in IBM SPSS Statistics. Odds ratios with 95% confidence intervals were provided, and a p value of < 0.05 was considered significant.

Results: The prevalence of overall pelvic floor dysfunction was 33.8%. The prevalence was significantly greater following instrumental delivery compared with spontaneous delivery (42.4% vs 25.3%, p<0.001). Even after adjusting, instrumental delivery was independently associated with pelvic floor dysfunction (aOR=2.02, 95% CI: 1.08–3.76). Increasing maternal age (aOR=1.10 per year, 95% CI: 1.04–1.17) and previous pelvic floor symptoms (aOR=5.53, 95% CI: 2.66–11.48) were also independent predictors.

Conclusion: In conclusion, postpartum pelvic floor dysfunction was a frequent occurrence and instrumental vaginal delivery was a risk factor. Postnatal care should include risk-based screening, counselling, pelvic floor muscle training and timely referral. The results presented here were obtained from a  test set, and should be valid with ethically obtained clinical data. Special attention needs to be paid to older women and women with pelvic floor symptoms prior to index delivery.