Cesarean and vaginal birth: cohort study of the impact on pelvic floor disorders

描述（由申请人提供）：鉴于每年有350,000例手术治疗尿失禁或其他盆底疾病（PFDs），需要有效的预防策略。产科医生将预防尿失禁作为选择性剖宫产的主要理由。然而，目前尚不清楚选择性剖宫产是否对预防pfd有效。特别是，几乎没有关于分娩方式对盆腔器官脱垂的长期发生率的影响的信息。2006年联合国儿童基金会关于产妇要求剖宫产的会议强调了这一点以及其他关于“患者选择”剖宫产的争议。为了研究选择性剖宫产在预防盆腔器官脱垂和其他PFDs方面的有效性，我们提出了一项队列研究，对1998- 2003年间分娩第一胎的1000名妇女进行了研究。未暴露组将是剖腹产（UCD）的妇女。我们将招募两组对照暴露人群，按首次分娩日期（3个月）与UCD组相匹配：剖宫产（LCD）分娩的妇女和阴道分娩（VB）分娩的妇女。将使用有效的问卷对这三组的尿失禁和肛门失禁的累积发生率进行评估。为了识别和分类盆腔器官脱垂，我们将对所有参与者进行标准化的体格检查。我们的具体目的是：(1)调查与分娩后剖宫产或顺产相比，未分娩剖宫产是否与PFDs累积发生率（分娩后5-10年）较低相关；(2)调查引产、会阴切开术和手术分娩等分娩干预措施是否对PFDs累积发生率有显著影响。此外，我们将(3)对入组参与者进行纵向队列研究，并每年对这三组进行随访，以调查pfd的长期发病率。我们将具体比较UCD组PFDs的发生率与LCD组和VB组的发生率。这项研究是新颖的，因为我们将重点比较UCD与其他分娩方式，因为我们将使用可重复的定量体检来评估脱垂，因为纵向设计将允许我们描述pfd随时间的发病率和自然历史。通过研究分娩如何影响女性盆底问题的风险，我们将为女性和她们的医生提供新的、有价值的信息。我们正处于产科的十字路口，剖宫产率创历史新高。我们的研究结果将与即将分娩的妇女直接相关，从公共卫生的角度来看，将有助于确定有效的预防方案。公共卫生相关性：鉴于美国每年有超过35万例大型手术用于治疗尿失禁和盆腔器官脱垂，预防策略至关重要。我们知道分娩是这些盆底问题的主要危险因素，但这项研究将调查是否

DESCRIPTION (provided by applicant): Given that 350,000 surgical procedures are performed each year to treat urinary incontinence or other pelvic floor disorders (PFDs), effective prevention strategies are needed. Obstetricians cite the prevention of incontinence as a primary justification for elective Cesarean delivery. However, it's not known whether elective Cesarean is effective in preventing PFDs. In particular, there is virtually no information about the impact that delivery mode has on the long-term incidence of pelvic organ prolapse. The 2006 NICHD conference on Cesarean Delivery on Maternal Request highlighted this and other controversies about "patient-choice" Cesarean. To investigate the effectiveness of elective Cesarean in preventing pelvic organ prolapse and other PFDs, we propose a cohort study of 1000 women who delivered a first child from 1998- 2003. The unexposed group will be women delivered by unlabored Cesarean delivery (UCD). We will recruit two comparison exposed populations, matched to the UCD group by date of first birth ( 3 months): women delivered by labored Cesarean delivery (LCD), and women delivered by vaginal birth (VB). The cumulative incidence of urinary and anal incontinence will be assessed in these three groups using validated questionnaires. To identify and classify pelvic organ prolapse, we will use a standardized physical examination for all participants. Our specific aims are: (1) to investigate whether unlabored Cesarean delivery is associated with a lower cumulative incidence of PFDs (5-10 years from delivery) than either Cesarean after the onset of labor or vaginal birth, and (2) to investigate whether labor interventions, such as labor induction, episiotomy and operative delivery, have a significant effect on the cumulative incidence of PFDs. In addition, we will (3) develop a longitudinal cohort study of enrolled participants and follow these three groups annually to investigate the long-term incidence of PFDs. We will specifically compare the incidence of PFDs in the UCD group with the incidence in the LCD and VB comparison groups. This study is novel because we will focus on comparing UCD to other modes of delivery, because we will use a reproducible and quantitative physical examination to assess prolapse, and because the longitudinal design will allow us to describe the incidence and natural history of PFDs over time. By studying how childbirth affects a woman's risk of pelvic floor problems, we will provide new, valuable information for women and their doctors. We are at a crossroads in obstetrics, with an all-time high in Cesarean birth. Our findings will have immediate relevance to women anticipating childbirth and, from a public health perspective, will help to identify effect prevention options. PUBLIC HEALTH RELEVANCE: Given that more than 350,000 major surgeries are performed in the US each year for treatment of incontinence and pelvic organ prolapse, prevention strategies are critical. We know that childbirth is a major risk factor for these pelvic floor problems, but this study will investigate whether Cesarean birth reduces the long-term risk of pelvic floor problems. By investigating whether Cesarean reduces incontinence and pelvic organ prolapse, we will provide information with immediate relevance to decisions faced by women and their obstetricians. From a public health perspective, this research will help to establish whether obstetrical care can be modified to prevent women's health problems later in life.