Short-term impact of mode of delivery on pelvic floor function in primiparous women: an updated systematic review and meta-analysis

OBJECTIVE: The effect of different modes of delivery on pelvic floor function remains incompletely defined. The main objective of this study was to analyze whether there is a short-term difference in pelvic floor strength and endurance in primiparous women according to their type of delivery: vaginal delivery vs. cesarean section. In addition, we sought to determine how both modes of delivery affected the presence of urinary incontinence and pelvic organ prolapse. DATA SOURCES: We conducted bibliographic searches in the Scopus, Web of Science, PubMed, and Cochrane databases up to February 2025. STUDY ELIGIBILITY CRITERIA, APPRAISAL AND SYNTHESIS METHODS: Observational studies evaluating pelvic floor function in primiparous women after vaginal delivery vs. cesarean section were included. Methodological quality was assessed using the list proposed by the Joanna Briggs Institute for cross-sectional and cohort studies. A random-effects meta-analysis was performed, calculating the effect size for quantitative variables using standardized mean differences (SMD) and for dichotomous variables based on the number of events and percentage. RESULTS: Fifteen studies were included. Significant differences were identified in pelvic floor muscle strength after vaginal delivery compared to cesarean section (SMD=-0.35; 95% CI: -0.57 to -0.13). No significant differences were identified in muscle endurance according to the mode of delivery (SMD=-0.26; 95% CI: -0.63 to 0.10). On the other hand, analysis of the presence of urinary incontinence showed an odds ratio of 3.02 (95% CI: 1.10 to 8.29). High heterogeneity was observed across analyses (I² range: high to very high), and the overall certainty of evidence assessed using the GRADE approach was low to very low. CONCLUSIONS: Primiparous women who undergo cesarean section may have greater pelvic floor strength than those who have vaginal delivery or instrumental vaginal delivery. In addition, the likelihood of urinary incontinence and prolapse may be higher in women who give birth vaginally. CONDENSATION: Although cesarean delivery preserves short-term pelvic floor strength better than vaginal delivery, the evidence is weak, and more longitudinal research is needed. El resumen está disponible en Español al final del artículo.