Results of a nationwide survey on practice patterns of Canadian obstetricians and gynaecologists regarding the mode of delivery after pelvic floor surgery

Abstract

It is not uncommon to be challenged with the dilemma of deciding the best mode of delivery in a patient with a history of previous pelvic floor surgery. We hypothesized that the trend would be a predilection towards cesarean section delivery in the context of a previous pelvic floor surgery, especially amongst Urogynaecologists. A nation-wide survey was sent through the Society of Obstetrics and Gynaecology of Canada to all physician members to assess the practice patterns regarding the preferred mode of delivery after pelvic floor surgery. A hundred and three members replied. Forty-seven percent would recommend a cesarean section (CS) when pregnant after a previous midurethral sling (MUS), 27.2 % would allow vaginal delivery, 10.7 % would not be affected in their decision by the MUS, 9.7 % would strongly advise against pregnancy and 4.9 % would suggest a cesarean section with a sterilization procedure. With a history of previous pelvic organ prolapse surgery (POP), 54.4 % would suggest a CS when pregnant, 21.4 % would strongly advise against pregnancy and only 15.5 % would allow the patient to deliver vaginally. Urogynaecologists are significantly more likely to strongly advise a patient with a previous MUS against pregnancy, compared to their peers practicing general obstetrics and gynaecology (OBGYN) (p = 0.04) or maternal fetal medicine (MFM) (p = 0.05). Larger studies and clear guidelines advising physicians to the optimum mode of delivery following a history of previous pelvic floor surgery are strongly needed.