Physical Therapy Post-Graduate Program, Federal University of São Carlos (UFSCar), Rodovia Washington Luis, km 235, São Paulo, CEP 13565-905, Brazil.
Department of Physiotherapy, Federal University of São Carlos (UFSCar), São Carlos, Brazil.
Int Urogynecol J. 2020 Aug;31(8):1497-1506. doi: 10.1007/s00192-020-04231-6. Epub 2020 Feb 15.
The literature presents controversial results regarding the role of delivery mode in pelvic floor muscle (PFM) function after birth. Some studies showed a greater impairment of PFM function after vaginal delivery compared with cesarean section, while others have not identified a significant difference between these two modes of delivery. This study aimed to investigate whether there was a difference in short-term PFM function after childbirth in primiparous women who underwent cesarean section compared with those who underwent vaginal delivery.
Up to December 2018, the PubMed-MEDLINE, CINAHL, Embase, Bireme, Scopus, Web of Science, and Science Direct databases were searched. Two independent reviewers performed the selection process based on titles, abstracts, and full-text reading. Observational studies comparing PFM function after cesarean section versus vaginal delivery in primiparous women were included. PRISMA guidelines and Cochrane recommendations were followed. Methodological quality of the primary studies was assessed through the checklist proposed by the Joanna Briggs Institute for cross-sectional studies. Random effects meta-analysis was performed to synthesize evidence regarding PFM strength in primiparous woman after vaginal delivery compared with cesarean section. The GRADE approach was applied to classify the quality of the evidence.
Eleven studies met the inclusion criteria and were included in this review. A total of 1726 primiparous women were analyzed after childbirth. Five studies were included in the meta-analysis. No difference in PFM strength after childbirth was identified when cesarean section was compared with vaginal delivery [standardized mean difference (SMD): -0.15, 95% confidence interval (CI): -0.85 to 0.56]. Differences in PFM strength were identified when patients who underwent cesarean section were compared with those with an episiotomy or instrumented vaginal delivery (SMD: -12.51, CI 95%: -24.57 to -0.44), favoring the cesarean section group. In both cases, the quality of evidence was classified as very low because of the observational design of the included studies and population heterogeneity.
There was no difference in short-term PFM strength after childbirth between primiparous women who underwent cesarean section or vaginal delivery, as assessed through vaginal manometry. However, we identified reduced PFM strength in women who underwent an episiotomy or instrumented vaginal delivery compared with those who underwent cesarean section. Nevertheless, this conclusion should be cautiously considered as the observational design of the primary studies and possible heterogeneity among the primiparous women included in the studies contributed to reducing the quality of the evidence synthesized. Future primary studies with longitudinal designs and long-term follow-up periods are needed to strengthen the quality of evidence and provide more conclusive evidence to guide clinical practice.
文献对于分娩方式对盆底肌（PFM）功能的影响存在争议。一些研究表明阴道分娩后 PFM 功能受损更严重，而另一些研究则未发现阴道分娩和剖宫产之间存在显著差异。本研究旨在调查初产妇剖宫产与阴道分娩后短期 PFM 功能是否存在差异。
截至 2018 年 12 月，检索了 PubMed-MEDLINE、CINAHL、Embase、Bireme、Scopus、Web of Science 和 Science Direct 数据库。两名独立评审员根据标题、摘要和全文阅读进行选择过程。纳入了比较初产妇剖宫产与阴道分娩后 PFM 功能的观察性研究。遵循 PRISMA 指南和 Cochrane 建议。使用 Joanna Briggs 研究所提出的检查表评估初级研究的方法学质量，用于横断面研究。对阴道分娩后初产妇 PFM 强度进行随机效应荟萃分析，以综合比较剖宫产与阴道分娩的证据。应用 GRADE 方法对证据质量进行分级。
11 项研究符合纳入标准，并纳入本综述。共有 1726 名初产妇在分娩后进行了分析。5 项研究纳入荟萃分析。剖宫产与阴道分娩后 PFM 强度无差异[标准化均数差（SMD）：-0.15，95%置信区间（CI）：-0.85 至 0.56]。与阴道分娩相比，行剖宫产术的患者与行会阴切开术或器械性阴道分娩的患者之间的 PFM 强度存在差异（SMD：-12.51，CI 95%：-24.57 至-0.44），剖宫产组占优势。在这两种情况下，由于纳入研究的观察设计和人群异质性，证据质量均被归类为极低。
通过阴道测压法评估，初产妇剖宫产与阴道分娩后短期 PFM 强度无差异。然而，与行剖宫产术的产妇相比，行会阴切开术或器械性阴道分娩的产妇的 PFM 强度降低。尽管如此，由于初级研究的观察设计和研究中初产妇的可能异质性，这一结论应谨慎考虑，这降低了综合证据的质量。需要进一步开展具有纵向设计和长期随访的初级研究，以提高证据质量，并提供更具结论性的证据来指导临床实践。
