Abstract
Objective
To estimate the influence of labour and pregnancy factors on long-term pelvic floor
health outcomes.
Methods
This population-based cohort study was conducted using linkage between the Nova Scotia
Atlee Perinatal Database, the Medical Services Insurance Database, and the Canadian
Institute for Health Information's Discharge Abstract Database from 1988 to 2006;
this allowed for the evaluation of patient utilization of care providers for pelvic
floor disorders and captured conservative and surgical interventions. We compared
rates of urinary and anal incontinence, pelvic organ prolapse, and fistula disorders
in women undergoing Caesarean section (CS) without labour and women undergoing labour
with any method of delivery. Multivariate logistic regression and survival (time-to-event)
analyses were performed.
Results
Absolute risks for the selected pelvic floor health outcomes were low, regardless
of whether labour was experienced in the first pregnancy. Women with one or more deliveries
who had a CS without labour in their first pregnancy had reduced risks for all pelvic
floor health outcomes, except fistula formation, and they were also less likely to
develop these outcomes during the study period.
Conclusion
Women undergoing obstetrically indicated CS without labour in their first delivery
may have reduced risks of pelvic floor health disorders, even after multiple deliveries.
These findings contribute important information for health care providers when counselling
women and their families who are weighing the risk of long-term pelvic floor disorders
against the benefits of spontaneous vaginal delivery.
Résumé
Objectif
Estimer l'influence des facteurs du travail et de la grossesse sur la santé du plancher
pelvien à long terme.
Méthodes
Cette étude de cohorte basée sur la population a été menée en utilisant le lien entre
la base de données périnatales Atlee de la Nouvelle-Écosse, la Medical Services Insurance
Database et la Base de données sur les congés des patients de l'Institut canadien
d'information sur la santé de 1988 à 2006; cela permet d'évaluer l'utilisation des
fournisseurs de soins par les patients pour les dysfonctions du plancher pelvien et
d'évaluer les prises en charge conservatives et les interventions chirurgicales. Nous
comparons les taux d'incontinences anale et urinaire, de prolapsus des organes pelviens
et les affections de la fistule chez les femmes subissant une césarienne (CS) sans
déclenchement du travail et les femmes qui subissent un déclenchement du travail avec
toute méthode d'accouchement. Des analyses de régression logistique multivariée et
de survie (temps avant l'événement) ont été effectuées.
Résultats
Les risques absolus sur les cas sélectionnés touchant la santé du plancher pelvien
étaient faibles, qu'il y ait eu une période de travail avant l'accouchement ou non
pour une première grossesse. Les femmes ayant eu un ou plusieurs accouchements qui
ont subi une CS sans déclenchement du travail lors de leur première grossesse ont
présenté moins de risques de complications touchant le plancher pelvien, la formation
d'une fistule exceptée, et il était aussi moins probable qu'elles développent ces
complications durant la période d'étude.
Conclusion
Les femmes ayant subi des CS indiquées pour des raisons obstétriques sans déclenchement
du travail lors de leur premier accouchement peuvent présenter moins de risques de
dysfonctionnement du plancher pelvien, même après plusieurs accouchements. Ces conclusions
contribuent à fournir d'importantes informations sur les fournisseurs de soins de
santé lorsqu'ils conseillent les femmes et leurs familles qui pèsent le risque entre
des dysfonctions du plancher pelvien à long terme et les avantages d'un accouchement
vaginal spontané.
Key Words
Abbreviations:
CIHI (Canadian Institute for Health Information), HDNS (Health Data Nova Scotia), HR (hazards ratio), MSI (Medical Services Insurance), MSID (Medical Services Insurance Database), NSAPD (Nova Scotia Atlee Perinatal Database)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: July 16, 2016
Accepted:
March 30,
2016
Received:
January 14,
2016
Footnotes
Competing interests: None declared.
Identification
Copyright
Copyright © 2016 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
