Does delayed child-bearing increase the risk of levator injury in labour?

BACKGROUND Levator trauma is common in parous women. We have recently found a relationship with age at first vaginal delivery in women seen before and after childbirth. AIMS To examine women presenting with symptoms of pelvic floor disorders for such an association. METHODS Eight hundred and one women were prospectively seen for an interview, clinical examination (including for levator integrity and function in 789 cases), multichannel urodynamic testing and pelvic floor ultrasound (including 3D imaging in 350 cases). Findings were tested for association with maternal age at first vaginal delivery, parity and operative vaginal delivery using logistic regression. RESULTS Mean age was 55.3 years (range 17-90), with 79% complaining of stress urinary incontinence and 28% of symptoms of prolapse. Median vaginal parity was 2 (range 0-12); mean age at first vaginal delivery was 24 (range 14-39). Levator defects were found in 170 women (21.6%), 24% of the vaginally parous. Defects were more common on the right (86%) than left (45%) (P<0.0001). Women with levator trauma had a higher mean age (25.5 (SD 5.2) vs 23.5 (SD 4.5) years, P<0.0001). Regression modelling confirmed findings, demonstrating an increase in the odds of levator trauma of approximately 10% for every year of delay in child-bearing. Vaginal operative delivery was associated with a near-doubling of the odds of trauma. CONCLUSIONS Increased maternal age is a risk factor for intrapartum pelvic floor trauma. The global trend towards delayed child-bearing may result in an increased prevalence of pelvic floor disorders in coming decades.