Childbirth and pelvic floor dysfunction: an epidemiologic approach to the assessment of prevention opportunities at delivery

Abstract

Female pelvic floor dysfunction is integral to the woman's role in the reproductive process, largely because of the unique anatomic features that facilitate vaginal birth and also because of the trauma that can occur during that event. Interventions such as primary elective cesarean delivery have been discussed for the primary prevention of pelvic floor dysfunction; however, existing data about potentially causal factors limit our ability to evaluate such strategies critically. Here we consider the conceptual principles of epidemiologic function and the availability of data that are necessary to make informed recommendations about prevention opportunities for pelvic floor dysfunction at delivery. Available epidemiologic data on pelvic floor dysfunction suggest that there may be substantial opportunities for the primary prevention of pelvic organ prolapse at delivery. Although definitive recommendations await further epidemiologic studies of the potential risk and benefits of obstetric practice change, it is hoped that this discussion will provide a novel, quantitative framework for the assessment of pelvic floor dysfunction prevention opportunities.

Figure

Schematic of attributable risk concept. The hatched area represents the attributable risk or the excess incidence of PFD in women that can be attributed to vaginal delivery, assuming causality (Adapted from Gordis L. More on risk: estimating the potential for prevention. In: Epidemiology. 2nd ed. Philadelphia: Saunders; 2000. p. 172–3.)