[Cesarean section and perineal protection: CNGOF Perineal Prevention and Protection in Obstetrics Guidelines]

Abstract

Objective: The endpoint was to assess the interest of planned cesarean section in primary and secondary obstetrical perineal prevention.

Methods: This is a review of the literature about the impact of the mode of delivery in urinary incontinence (UI), anal incontinence (AI), pelvic organ prolapse (POP), sexual disorders de novo or prior to delivery and history of obstetric anal sphincter injuries (OASI).

Results: The studies about UI, AI and sexual disorders report a potential protective impact of cesarean section but with a possible selection bias and an inadequate comparability of the groups. Randomized trials do not report any protective effect of planned cesarean section for these 3 disorders. The literature about POP reports a higher risk for the women who delivered vaginally but still with a possible selection bias et there is no randomized trial for this outcome. About the secondary prevention of OASI, there is no evidence in the literature for a benefit of a systematic planned cesarean section for all women. For symptomatic women, the mode of delivery has to be discussed individually. In secondary prevention of UI, AI, POP and sexual disorders, there is no evidence in the literature for a benefit of planned cesarean section even if there is a history of surgical procedure for the disorder.

Conclusion: Planned cesarean section is not recommended in order to prevent primary or secondary obstetrical perineal disorders except for symptomatic OASI for whom an individual discussion about the mode of delivery is recommended.

Keywords: Accouchement; Cesarean; Césarienne; Delivery; Incontinence; Lésion obstétricale du sphincter anal; Obstetric anal sphincter injury; Pelvic floor disorders; Troubles périnéaux.