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Delivery Determinants of Pelvic Floor Dysfunction and Pelvic Floor Muscle Strength among Post-Partum Women in an NHS Trust in The North of England: A Cross-sectional Retrospective Observational Study.
  • Alejandro Gonzalez-Aquines,
  • Jenna Attew,
  • Elizabeth Doxford-Hook
Alejandro Gonzalez-Aquines
University of Bradford Faculty of Health Studies

Corresponding Author:[email protected]

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Jenna Attew
University of Bradford Faculty of Health Studies
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Elizabeth Doxford-Hook
University of Leeds School of Healthcare
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Abstract

Objective: To identify what delivery determinants are associated with higher risks of Pelvic floor dysfunction (PFD) among early post-partum women receiving Pelvic Health Physiotherapy (PHP) care for PFD at a National Health Service (NHS) Trust in the North of England. Design: Quantitative non-experimental retrospective observational design. Setting: PHP Urogynaecology Unit at Leeds Teaching Hospital. Population: Women under six months post-partum referred to PHP with symptoms of PFD between 1st June 2021 and 1st June 2022. Methods: Data on the type of delivery, the number of subjectively reported PFD symptoms and pelvic floor muscle (PFM) strength, graded using the modified Oxford scale, on initial physiotherapy consultation collected from physiotherapy records. Data on risk factors for PFD not related to the mode of delivery were also collected. Main Outcome Measures: Number of PFD symptoms and PFM strength (modified Oxford score) documented on assessment. Results: 166 post-partum physiotherapy records were included. Forceps delivery was identified as the type of delivery most associated with PFD symptoms (2.45 ± 0.884 vs 1.85 ± 0.813; p=<0.001; CI 0.92-0.28) and PFM weakness (2.15 ± 0.731 vs 2.5 ± 0.914; p=0.02; CI 0.04-0.66) compared to spontaneous vaginal delivery. Age 35 years or above was the only factor with a statistically significant association of PFD (OR 1.079; CI 95% 1.011 - 1.15). Conclusions: Forceps delivery increases PFD and PFM weakness, while age above 35 a major risk factor to develop PFD. Improvements to reduce the use of forceps and increase awareness of PFD and physiotherapy among women 35 years or above are needed.