Impact of mode of delivery of twins on the pelvic floor 3 and 12 months post-partum—part II

  • Fanny Béchard
  • Christel Castelli
  • Sandrine Alonso
  • Emmanuelle Vintejoux
  • François Goffinet
  • Vincent Letouzey
  • Thomas Schmitz
  • Renaud de TayracEmail author
Original Article


Introduction and hypothesis

To compare the impact of vaginal delivery (VD) versus cesarean section (CS) on the pelvic floor in twin primiparae at 3 and 12 months postpartum.


This comparative multicenter prospective cohort from a large French national cohort study consisted of primiparas who gave birth to live twins after 34 weeks of gestation. The primary end point was the postnatal urinary incontinence rate 3 months postpartum. The secondary end points were the pelvic floor dysfunction (PFD) at 3 and 12 months based on PFDI-20, PFIQ-7, PISQ-12, and SF-12 responses.


A total of 2812 patients in 172 French maternity units were recruited between February 2014 and March 2015: 1076 (38%) responded at 3 and 12 months (61% at 3 months); 1155 were analyzed at 3 months (556 VD and 599 CS) and 800 at 12 months (394 VD and 406 CS). VD was associated with more symptoms at 3 months [median PFDI-20 score 25/300 (8–50) vs. 17/300 (4–36) after CS; p < 0.0001]. Vaginal bulge was more frequently reported after VD (9 vs. 4%; p = 0.0015). Abdnormal PFD-related quality-of-life scores (scores > 0) were more frequent after VD at 3 months (58 vs. 42%; p < 0.0001) and 12 months (57 vs. 43%; p = 0.0020), indicating greater discomfort. However, SF-12 scores were higher after VD [56 (53–59) vs. 55 (51–58)] at 12 months, indicating better general quality of life.


Mode of delivery is significantly associated with pelvic organ prolapse symptoms 3 months postpartum, which regress by 12 months, probably because of the known spontaneous postnatal improvement of PFDs.


Pelvic floor dysfunction Pelvic organ prolapse Twin pregnancy Postpartum Risk factors Vaginal delivery 



This study was funded by the Nimes University Hospital (AOI GCS Merri Nîmes-Montpellier).

Compliance with ethical standards

Details of ethics approval

This study was approved by the Comité consultatif sur le traitement de l’information en matière de recherche dans le domaine de la santé and by the Commission Nationale de l’Informatique et des Libertés (autorization no. 913448).

The study was recorded on at no. NCT02059746.

Conflicts of interest



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Copyright information

© The International Urogynecological Association 2018

Authors and Affiliations

  • Fanny Béchard
    • 1
  • Christel Castelli
    • 2
  • Sandrine Alonso
    • 2
  • Emmanuelle Vintejoux
    • 3
  • François Goffinet
    • 4
  • Vincent Letouzey
    • 1
  • Thomas Schmitz
    • 5
  • Renaud de Tayrac
    • 1
    Email author
  1. 1.Department of Obstetrics and GynecologyCarémeau University HospitalNîmesFrance
  2. 2.Department of Biostatistics, Epidemiology, Public Health, and Medical Information (BESPIM)Nîmes University HospitalNîmesFrance
  3. 3.Department of Obstetrics and GynecologyArnaud de Villeneuve University HospitalMontpellierFrance
  4. 4.INSERM UMR 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), DHU Risks in PregnancyParis Descartes UniversityParisFrance
  5. 5.Department of Obstetrics and GynecologyRobert Debré University HospitalParisFrance

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