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The effect of the length of the second stage of labor on pelvic floor dysfunction

  • Bobby D. O'LEARY
    Correspondence
    CORRESPONDENCE: Dr Bobby D. O'Leary, MRCPI, MRCOG, Department of Urogynaecology, National Maternity Hospital, Holles Street, Dublin 2, Ireland
    Affiliations
    Department of Urogynaecology, National Maternity Hospital, Holles Street, Dublin 2, Ireland

    UCD Perinatal Research Centre, National Maternity Hospital, Holles Street, Dublin 2, Ireland
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  • Declan P. KEANE
    Affiliations
    Department of Urogynaecology, National Maternity Hospital, Holles Street, Dublin 2, Ireland

    Royal College of Surgeons in Ireland, National Maternity Hospital, Holles Street, Dublin 2, Ireland
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Published:November 02, 2022DOI:https://doi.org/10.1016/j.ajogmf.2022.100795

      Abstract

      Background

      : Pelvic floor dysfunction refers to any combination of incontinence, overactive bladder, pelvic organ prolapse, and sexual dysfunction. Pelvic floor dysfunction affects approximately 25-30% of women and is linked to parity and age. Some obstetric risk factors have been highlighted, though the second stage of labor has not been as thoroughly investigated. Allowing a longer second stage has been suggested as a method of reducing rates of cesarean section in nulliparous women, though has been linked to pelvic floor injuries.

      Objective

      : To determine the effect of the length of the second stage of labor on self-reported pelvic floor dysfunction

      Study Design

      : This was a single-centre prospective cohort study in a tertiary referral obstetric unit. Nulliparous women attending routine antenatal clinics were recruited to complete the Australian Pelvic Floor Questionnaire during pregnancy, and again three months after delivery. The primary outcome in this study was the effect of the length of the second stage of labor on total pelvic floor scores when analysed using multiple regression. The models were adjusted for the mother's age, mother's body mass index, length of the second stage of labor, fetal birthweight, mode of delivery, and perineal trauma. Secondary outcomes included the comparison of maternal, obstetric, and functional pelvic floor outcomes based on the mode of delivery and the length of the second stage of labor.

      Results

      : Among the 295 women who were recruited, the length of the second stage of labor and body mass index were associated with self-reported bladder dysfunction on multiple regression, while maternal age was protective. Compared to those with 60-120 minutes or less than 60 minutes, women with a second stage of longer than 120 minutes had higher rates of stress incontinence (85.7% [>120 mins] vs 41.7% [60 – 120 mins] or 52.5% [<60 mins], p = .001), urinary urgency (89.3% [>120 mins] vs 39.6% [60 – 120 mins] or 53.8% [<60 mins], p < .001), and fecal incontinence (10.7% [>120 mins] vs 0% [60 – 120 mins] or 1.2% [<60 mins], p = .027). There were no differences in the rate of sexual activity or dyspareunia. Women delivering vaginally had higher rates of stress incontinence (57.6% vs 38.0%, p = .006) compared to those delivered by cesarean section, though there were no differences in other pelvic floor symptoms or pelvic floor scores.

      Conclusions

      : A prolonged second stage of labor is associated with more self-reported bladder dysfunction at three months postnatal in primiparous women. Women with a longer second stage of labor should be informed about the risk of short-term bladder dysfunction, though the prevalence of long-term sequelae is unknown.

      Funding

      : None.

      Keywords

      Abbreviations:

      APFQ (Australian Pelvic Floor Questionnaire), BMI (Body mass index), OASI (Obstetric anal sphincter injury), PFD (Pelvic floor dysfunction), SUI (Stress urinary incontinence), SVD (Spontaneous vaginal delivery)
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