Does Mode of Delivery Affect the Incidence of Pelvic Organ Prolapse? A Systematic Review

Abstract

The study aim is to analyze research on the link between delivery mode and pelvic organ prolapse (POP). A thorough search across four databases identified 416 relevant publications. After removing duplicates using Rayyan QCRI and screening for relevance, the search yielded 193 publications, of which 78 full-text articles were reviewed, and 6 met the eligibility criteria for evidence synthesis. This review analyzed six studies encompassing 11,790 women. The prevalence of POP varied widely, from 3.5% to 51.3%. Across all studies comparing vaginal and cesarean deliveries, vaginal birth consistently demonstrated a higher association with POP, reinforcing its role as a significant risk factor. Vaginal delivery was associated with increased pelvic muscle strain and tearing, contributing to prolapse, while cesarean section (CS) provided some protection against advanced-stage POP postpartum. However, cesarean birth was also linked to potential long-term pelvic muscle dysfunction. Vaginal delivery was identified as a major risk factor for anterior vaginal wall prolapse, with additional contributors including sphincter damage, perineal tears, prolonged labor, and assisted delivery. This review highlights vaginal delivery as a major risk factor for POP, while cesarean section appears to offer some protective benefits. However, due to the potential risks of cesarean birth, a balanced approach to delivery planning is essential. Future research should investigate long-term pelvic floor outcomes and preventive measures to reduce prolapse risk while ensuring maternal and neonatal well-being. Clinicians should incorporate these insights into patient counseling and postpartum care to promote better pelvic health.