Pelvic floor dysfunction after vaginal delivery: MOODS-a prospective study

Area of Science:

• Obstetrics and Gynecology
• Pelvic Floor Disorders
• Maternal Health

Background:

• Labor and delivery can lead to pelvic floor dysfunction (PFD).
• The specific impact of operative vaginal delivery (OVD), particularly spatula use, on PFD is not well understood.

Purpose of the Study:

• To compare postpartum PFD symptoms between women who had a spontaneous vaginal delivery (SVD) and those who underwent OVD.

Main Methods:

• An observational prospective study (MOODS) recruited singleton term deliveries.
• PFD symptoms were assessed using the Pelvic Floor Distress Inventory-20 (PFDI-20) at 3, 6, and 12 months postpartum.
• Participants included spontaneous vaginal delivery (SVD) and operative vaginal delivery (OVD) groups, with OVD including spatula and vacuum extractor use.

Main Results:

• Women undergoing OVD, particularly with spatulas, had higher rates of nulliparity, episiotomy, neuraxial anesthesia, postpartum pain, and occiput-posterior positions.
• At 3 months postpartum, OVD and spatula-assisted deliveries were associated with higher Urinary Distress Inventory (UDI) and Pelvic Organ Prolapse Distress Inventory (POPDI) scores.
• These associations persisted for POPDI scores even after controlling for confounding variables, with no significant differences observed at 6 or 12 months.

Conclusions:

• Operative vaginal delivery, especially when using spatulas, is associated with a higher prevalence of early postpartum PFD symptoms.
• Pelvic organ prolapse symptoms appear to be the primary concern in the early postpartum period following spatula-assisted OVD.