Pelvic floor dysfunction after intervention, compared with expectant management, in prolonged second stage of labour: A population-based questionnaire and cohort study.

Autor: Bergendahl S; Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.; BB Sankt Göran, Capio Sankt Göran Hospital, Stockholm, Sweden., Sandström A; Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.; Department of Women's Health, Karolinska University Hospital, Stockholm, Sweden., Zhao H; Department of Epidemiology and Biostatistics, School of Public Health, Texas University, College Station, Texas, USA., Snowden JM; School of Public Health, Oregon Health and Science University - Portland State University, Portland, Oregon, USA.; Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon, USA., Brismar Wendel S; Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.; Department of Women's Health, Danderyd Hospital, Stockholm, Sweden.
Jazyk: angličtina
Zdroj: BJOG : an international journal of obstetrics and gynaecology [BJOG] 2024 Aug; Vol. 131 (9), pp. 1279-1289. Date of Electronic Publication: 2024 Feb 20.
DOI: 10.1111/1471-0528.17792
Abstrakt: Objective: To investigate the effect of vacuum extraction (VE) or caesarean section (CS), compared with expectant management, on pelvic floor dysfunction (PFD) 1-2 years postpartum in primiparous women with a prolonged second stage of labour.
Design: A population-based questionnaire and cohort study.
Setting: Stockholm, Sweden.
Population: A cohort of 1302 primiparous women with a second stage duration of ≥3 h, delivering from December 2017 to November 2018.
Methods: The 1-year follow-up questionnaire from the Swedish National Perineal Laceration Register was distributed 12-24 months postpartum. Exposure was VE or CS at 3-4 h or 4-5 h, compared with expectant management.
Main Outcome Measures: Pelvic floor dysfunction was defined as at least weekly symptoms of urinary incontinence, pelvic organ prolapse or a Wexner score of ≥4. The risk of PFD was calculated using Poisson regression with robust variance estimation, presented as crude and adjusted relative risks (RRs and aRRs) with 95% confidence intervals (95% CIs). The implication of obstetric anal sphincter injury (OASI) on pelvic floor disorders was investigated through mediation analysis.
Results: In total, 35.1% of women reported PFD. Compared with expectant management, the risk of PFD was increased after VE at 3-4 h (aRR 1.33, 95% CI 1.06-1.65) and 4-5 h (aRR 1.34, 95% CI 1.05-1.70), but remained unchanged after CS. The increased risk after VE was not mediated by OASI.
Conclusions: Pelvic floor dysfunction was common in primiparous women after a prolonged second stage, and the risk of PFD increased after VE but was unaffected by CS, compared with expectant management. If a spontaneous vaginal delivery eventually occurred, allowing an extended duration of labour did not increase the risk of PFD.
(© 2024 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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