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Asociación del modo de parto con trastornos del suelo pélvico después del parto

Joan L Blomquist¹, Alvaro Muñoz², Megan Carroll²

¹Department of Gynecology, Greater Baltimore Medical Center, Maryland.

|December 19, 2018

Resumen

El parto por cesárea reduce el riesgo de trastornos del suelo pélvico como la incontinencia urinaria en comparación con el parto vaginal. El parto vaginal quirúrgico aumenta el riesgo de incontinencia anal y prolapso de órganos pélvicos.

Área de la Ciencia:

Obstetricia y ginecología
Investigación sobre la salud pélvica

Sus antecedentes:

Los trastornos del suelo pélvico (PFD) afectan a aproximadamente el 25% de las mujeres estadounidenses y están relacionados con el parto.
La progresión a largo plazo de los PFD después del parto no se comprende bien.

Objetivo del estudio:

Determinar la incidencia de las DFP después del parto.
Identificar los factores maternos y obstétricos asociados con el desarrollo de PFD 1-2 décadas después del parto.

Principales métodos:

Un estudio de cohorte prospectivo siguió a 1528 mujeres hasta 9 años después de su primer parto.
Las participantes se clasificaron por modo de parto: cesárea, parto vaginal espontáneo o parto vaginal operativo.
Los trastornos del suelo pélvico, incluida la incontinencia urinaria por esfuerzo (SUI), la vejiga hiperactiva (OAB), la incontinencia anal (AI) y el prolapso de órganos pélvicos (POP), se evaluaron anualmente.

Principales resultados:

Durante una mediana de seguimiento de 5,1 años, se estimaron las incidencias acumuladas de 15 años.
En comparación con el parto vaginal espontáneo, el parto por cesárea mostró riesgos significativamente más bajos para IUS, OAB y POP.
El parto vaginal operativo se asoció con riesgos significativamente más altos para la IA y el POP. Un tamaño más grande del hiato genital aumentó independientemente el riesgo de POP.

Conclusiones:

El parto por cesárea parece proteger contra el desarrollo de ISU, OAB y POP en comparación con el parto vaginal espontáneo.
El parto vaginal quirúrgico aumenta el riesgo de AI y POP.
El tamaño del hiato genital es un factor de riesgo significativo para el POP, independientemente del método de administración.

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