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Cited by 65Pelvic floor disorders treatmentsMaternal and Perinatal Health InterventionsPregnancy-related medical research

Forceps delivery is associated with increased risk of pelvic organ prolapse and muscle trauma: a cross-sectional study 16-24 years after first delivery: Prolapse and delivery

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Volløyhaug, I., Mørkved, S., Salvesen, Ø., Salvesen, K. Å.·2015·Ultrasound in Obstetrics & Gynecology
DOI 10.1002/uog.14891
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Abstract

OBJECTIVES: To study possible associations between mode of delivery and pelvic organ prolapse (POP) and pelvic floor muscle trauma 16-24 years after first delivery and, in particular, to identify differences between forceps and vacuum delivery. METHODS: This was a cross-sectional study including 608 women who delivered their first child in 1990-1997 and were examined with POP quantification (POP-Q) and pelvic floor ultrasound in 2013-2014. Outcome measures were POP ≥ Stage 2 or previous prolapse surgery, levator avulsion and levator hiatal area on Valsalva. Univariable and multivariable logistic regression analyses and ANCOVA were applied to identify outcome variables associated with mode of delivery. RESULTS: Comparing forceps to vacuum delivery, the adjusted odds ratios (aOR) were 1.72 (95% CI, 1.06-2.79; P = 0.03) for POP ≥ Stage 2 or previous prolapse surgery and 4.16 (95% CI, 2.28-7.59; P < 0.01) for levator avulsion. Hiatal area on Valsalva was larger, with adjusted mean difference (aMD) of 4.75 cm(2) (95% CI, 2.46-7.03; P < 0.01). Comparing forceps with normal vaginal delivery, the adjusted odds ratio (aOR) was 1.74 (95% CI, 1.12-2.68; P = 0.01) for POP ≥ Stage 2 or surgery and 4.35 (95% CI, 2.56-7.40; P < 0.01) for levator avulsion; hiatal area on Valsalva was larger, with an aMD of 3.84 cm(2) (95% CI, 1.78-5.90; P < 0.01). Comparing Cesarean delivery with normal vaginal delivery, aOR was 0.06 (95% CI, 0.02-0.14; P < 0.01) for POP ≥ Stage 2 or surgery and crude OR was 0.00 (95% CI, 0.00-0.30; P < 0.01) for levator avulsion; hiatal area on Valsalva was smaller, with an aMD of -8.35 cm(2) (95% CI, -10.87 to -5.84; P < 0.01). No differences were found between vacuum and normal vaginal delivery. CONCLUSIONS: We found that mode of delivery was associated with POP and pelvic floor muscle trauma in women from a general population, 16-24 years after their first delivery. Forceps was associated with significantly more POP, levator avulsion and larger hiatal areas than were vacuum and normal vaginal deliveries. There were no statistically significant differences between vacuum and normal vaginal deliveries. Cesarean delivery was associated with significantly less POP and pelvic floor muscle trauma than were normal or operative vaginal delivery.

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  • Forceps delivery was reported as a significant risk factor and as a significant protective factor for primary pelvic organ prolapse compared with normal vaginal delivery.

    “Forceps delivery was reported as a significant risk factor and as a significant protective factor for primary POP compared with normal vaginal delivery.”

    From Risk factors for primary pelvic organ prolapse and prolapse recurrence: an updated systematic review and meta-analysis (2022) · cites this paper as [28]

    The Results report a statistically significant increase in pelvic organ prolapse after forceps delivery compared with normal vaginal delivery. The Introduction notes that another study found a protective effect, but does not say that effect was statistically significant; this paper’s own findings do not show a protective effect. Page numbers were not available in our copy. (LLM, conf=0.86)

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  • Cesarean delivery was statistically significantly protective against primary pelvic organ prolapse compared with normal vaginal delivery (n=2, pooled OR 0.08; 95% CI 0.03-0.20).

    “Cesarean delivery was statistically significantly protective against primary POP when compared with normal vaginal delivery (n¼2, pooled OR, 0.08; 95% CI, 0.03e0.20)”

    From Risk factors for primary pelvic organ prolapse and prolapse recurrence: an updated systematic review and meta-analysis (2022) · cites this paper as [28]

    The Results report that cesarean delivery was associated with significantly lower odds of POP ≥ Stage 2 or previous surgery than normal vaginal delivery. But this was a single cross-sectional study, not a two-study pooled estimate: its adjusted OR was 0.06 (95% CI 0.02–0.14), not 0.08 (0.03–0.20). The paper also does not label its outcome “primary POP.” (LLM, conf=0.91)

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  • No significant association was found between vacuum delivery and primary pelvic organ prolapse (n=2, pooled OR 0.88; 95% CI 0.45-1.73).

    “No significant association was found between vacuum delivery and primary POP (n¼2, pooled OR, 0.88; 95% CI, 0.45e1.73)”

    From Risk factors for primary pelvic organ prolapse and prolapse recurrence: an updated systematic review and meta-analysis (2022) · cites this paper as [28]

    The Results (page not provided) report no statistically significant difference in POP prevalence between vacuum and normal vaginal delivery. But this paper reports a single cross-sectional study, not a two-study pooled analysis, and it does not give the claimed pooled OR of 0.88 (95% CI 0.45–1.73). (LLM, conf=0.90)

    Experimental — accuracy not yet measured

  • The pooled odds ratio for forceps delivery was not statistically significant (n=2, pooled OR 1.05; 95% CI 0.57-1.94).

    “The pooled OR was not statistically significant (n¼2, pooled OR, 1.05; 95% CI, 0.57e1.94).”

    From Risk factors for primary pelvic organ prolapse and prolapse recurrence: an updated systematic review and meta-analysis (2022) · cites this paper as [28]

    The Statistical analysis section describes a cross-sectional study using logistic regression, not a pooled analysis of two studies. The Results report significant forceps associations for pelvic organ prolapse and levator avulsion, but do not report the claimed pooled OR of 1.05 (95% CI 0.57–1.94). Searches for that estimate and for a pooled forceps analysis found no matching passage. (LLM, conf=0.78)

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Research works printed but not linked: 1

  1. [35]35. Thomas V, Shek C, Rojas RAG, Dietz HP. The latency between pelvic floor trauma and presentation for prolapse surgery. Ultrasound Obstet Gynecol 2013; 42: 39.

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Authors
Volløyhaug, I., Mørkved, S., Salvesen, Ø., & Salvesen, K. Å.
Affiliations
Norwegian University of Science and Technology (NO)
Corresponding author
Volløyhaug, I.
ORCID
Venue
Ultrasound in Obstetrics & Gynecology
Publisher
Wiley
Published
2015-08-25
Volume
46
Issue
4
Pages
487-495
ISSN
0960-7692 (ISSN-L)
DOI
10.1002/uog.14891
OpenAlex
W2113124860
Semantic Scholar
b5b07672145eda536ccbc521f4a2f32411d52b1b
Cited by
65
References
36
Citations by year
2026: 3 · 2025: 7 · 2024: 6 · 2023: 6 · 2022: 6 · 2021: 4 · 2020: 5 · 2019: 10 · 2018: 7 · 2017: 4 · 2016: 4 · 2015: 3
FWCI
5.04
Type
journal article
Language
en
Open access
Licence
doi.wiley.com/10.1002/tdm_license_1.1 (tdm, 7 d)
Locations
  • Ultrasound in Obstetrics and Gynecology (publishedVersion)
  • PubMed (publishedVersion)
Funders
the Norwegian Extra Foundation for Health and Rehabilitation through EXTRA funds (2012-2-186)
Topics
  • Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
  • Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pregnancy-related medical research
Keywords
pelvic organ prolapse, forceps delivery, vacuum extraction, mode of delivery, levator avulsion, cesarean section, vaginal delivery, postpartum complications, POP-Q, pelvic floor ultrasound, pelvic floor surgery, pelvic organ prolapse surgery, Valsalva maneuver, levatorplasty
MeSH terms
Adult, Anus Diseases, Cesarean Section, Cross-Sectional Studies, Female, Humans, Middle Aged, Norway, Pain, Parity, Pregnancy, Quality of Life, Surgical Instruments, Ultrasonography, Vacuum Extraction, Obstetrical, Pelvic Organ Prolapse, Pelvic Floor Disorders

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