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Effect of prolonged second stage of labor on pelvic floor function: A prospective cohort study

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Abstract

Introduction and hypothesis

To evaluate the effect of the second stage of labor (SSL) lasting > 2 h on pelvic floor function.

Methods

This single-center prospective cohort study included primiparous women with SSL > 2 h treated at Tongji Hospital between January 2018 and December 2019 (case group). A matched group of women with similar newborn weight and SSL < 2 h were recruited simultaneously (control group). Stress urinary incontinence (SUI) and pelvic floor muscle (PFM) characteristics were measured at 6 weeks, 6 months, and finally 1 year postpartum.

Results

A total of 63 pairs of primiparous women completed 1-year follow-up. The incidence of SUI in the case group was significantly higher than that in the control group at 6 weeks postpartum (P = 0.020); however, the differences were not significant at 1 year postpartum (P=1.00). PFM endurance was significantly lower in the case group at 6 weeks (P = 0.000), 6 months (P = 0.000), and 1 year (P = 0.011) after childbirth. There was no difference in PFM strength between the two groups. The maximal voluntary contraction (MVC) of PFM was significantly lower in the case group at 6 weeks postpartum (P = 0.007), but the differences were not significant at 1 year postpartum (P = 0.197). PFM endurance and MVC were higher at 1 year than at 6 weeks postpartum in both groups.

Conclusions

The SSL > 2 h increased the incidence of SUI at 6 weeks postpartum and decreased PFM endurance for 1 year.

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References

  1. Wu JM, Matthews CA, Conover MM, Pate V, Jonsson FM. Lifetime risk of stress urinary incontinence or pelvic organ prolapse surgery. Obstet Gynecol. 2014;123(6):1201–6. https://doi.org/10.1097/AOG.0000000000000286.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Lowenstein E, Ottesen B, Gimbel H. Incidence and lifetime risk of pelvic organ prolapse surgery in Denmark from 1977 to 2009. Int Urogynecol J. 2015;26(1):49–55. https://doi.org/10.1007/s00192-014-2413-y.

    Article  PubMed  Google Scholar 

  3. Zhang L, Zhu L, Xu T, Lang J, Li Z, Gong J, et al. A population-based survey of the prevalence, potential risk factors, and symptom-specific bother of lower urinary tract symptoms in adult Chinese women. Eur Urol. 2015;68(1):97–112. https://doi.org/10.1016/j.eururo.2014.12.012.

    Article  PubMed  Google Scholar 

  4. Chen CCG, Avondstondt AM, Khatry SK, Singh M, Klasen EM, LeClerq SC, et al. Prevalence of symptomatic urinary incontinence and pelvic organ prolapse among women in rural Nepal. Int Urogynecol J. 2020;31(9):1851–8. https://doi.org/10.1007/s00192-019-04129-y.

    Article  PubMed  Google Scholar 

  5. Blomquist JL, Munoz A, Carroll M, Handa VL. Association of delivery mode with pelvic floor disorders after childbirth. Jama. 2018;320(23):2438–47. https://doi.org/10.1001/jama.2018.18315.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Volloyhaug I, Morkved S, Salvesen O, Salvesen K. Pelvic organ prolapse and incontinence 15-23 years after first delivery: a cross-sectional study. BJOG: Int J Obstet Gynaecol. 2015;122(7):964–71. https://doi.org/10.1111/1471-0528.13322.

    Article  CAS  Google Scholar 

  7. Samuelsson EC, Victor FT, Tibblin G, Svardsudd KF. Signs of genital prolapse in a Swedish population of women 20 to 59 years of age and possible related factors. Am J Obstet Gynecol. 1999;180(2 Pt 1):299–305. https://doi.org/10.1016/s0002-9378(99)70203-6.

    Article  CAS  PubMed  Google Scholar 

  8. Zhang J, Landy HJ, Ware Branch D, Burkman R, Haberman S, Gregory KD, et al. Contemporary patterns of spontaneous labor with normal neonatal outcomes. Obstet Gynecol. 2010;116(6):1281–7. https://doi.org/10.1097/AOG.0b013e3181fdef6e.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Organization WH. WHO recommendations: Intrapartum care for a positive childbirth experience. Geneva: World Health Organization; 2018.

    Google Scholar 

  10. Pardo E, Rotem R, Glinter H, Erenberg M, Yahav L, Yohay Z, et al. Recovery from pelvic floor dysfunction symptoms in the postpartum is associated with the duration of the second stage of labor. Archives Gynecol Obstet. 2019;300(1):127–33. https://doi.org/10.1007/s00404-019-05173-1.

    Article  Google Scholar 

  11. Meyer S, Salchli F, Hohlfeld P, Baud D, Vial Y, Achtari C. Continuous recording of intrarectal pressures during the second phase of labour: correlations with postpartum pelvic floor complaints. Biomech-Clin Study Int Urogynecol J. 2017;28(8):1209–16. https://doi.org/10.1007/s00192-016-3249-4.

    Article  PubMed  Google Scholar 

  12. Marsoosi V, Jamal A, Eslamian L, Oveisi S, Abotorabi S. Prolonged second stage of labor and levator ani muscle injuries. Global J Health Sci. 2014;7(1):267–73. https://doi.org/10.5539/gjhs.v7n1p267.

    Article  Google Scholar 

  13. Haylen B, de Ridder D, Freeman R, Swift S, Berghmans B, Lee J, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J. 2010;21(1):5–26. https://doi.org/10.1007/s00192-009-0976-9.

    Article  PubMed  Google Scholar 

  14. Avery K, Donovan J, Peters TJ, Shaw C, Gotoh M, Abrams P. ICIQ: a brief and robust measure for evaluating the symptoms and impact of urinary incontinence. Neurourol Urodynam. 2004;23(4):322–30. https://doi.org/10.1002/nau.20041.

    Article  Google Scholar 

  15. Yang S, Sang W, Feng J, Zhao H, Li X, Li P, et al. The effect of rehabilitation exercises combined with direct vagina low voltage low frequency electric stimulation on pelvic nerve electrophysiology and tissue function in primiparous women: A randomised controlled trial. J Clin Nurs. 2017;26(23-24):4537–47. https://doi.org/10.1111/jocn.13790.

    Article  PubMed  Google Scholar 

  16. Tähtinen RM, Cartwright R, Tsui JF, Aaltonen RL, Aoki Y, Cárdenas JL, et al. Long-term impact of mode of delivery on stress urinary incontinence and urgency urinary incontinence: a systematic review and meta-analysis. Eur Urol. 2016;70(1):148–58. https://doi.org/10.1016/j.eururo.2016.01.037.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Petros P. The integral system. Central Eur J Urol. 2011;64(3):110–9. https://doi.org/10.5173/ceju.2011.03.art1.

    Article  Google Scholar 

  18. Rostaminia G, Peck JD, Van Delft K, Thakar R, Sultan A, Shobeiri SA. New measures for predicting birth-related pelvic floor trauma. Female Pelvic Med Reconstruct Surg. 2016;22(5):292–6. https://doi.org/10.1097/SPV.0000000000000282.

    Article  Google Scholar 

  19. Yohay D, Weintraub AY, Mauer-Perry N, Peri C, Kafri R, Yohay Z, et al. Prevalence and trends of pelvic floor disorders in late pregnancy and after delivery in a cohort of Israeli women using the PFDI-20. Eur J Obstet Gynecol Reproduct Biol. 2016;200:35–9. https://doi.org/10.1016/j.ejogrb.2016.02.037.

    Article  Google Scholar 

  20. Nygaard IE, Clark E, Clark L, Egger MJ, Hitchcock R, Hsu Y, et al. Physical and cultural determinants of postpartum pelvic floor support and symptoms following vaginal delivery: a protocol for a mixed-methods prospective cohort study. BMJ open. 2017;7(1):e014252. https://doi.org/10.1136/bmjopen-2016-014252.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Valsky DV, Lipschuetz M, Bord A, Eldar I, Messing B, Hochner-Celnikier D, et al. Fetal head circumference and length of second stage of labor are risk factors for levator ani muscle injury, diagnosed by 3-dimensional transperineal ultrasound in primiparous women. Am J Obstet Gynecol. 2009;201(1):91 e1–7. https://doi.org/10.1016/j.ajog.2009.03.028.

    Article  Google Scholar 

  22. Shek KL, Dietz HP. Intrapartum risk factors for levator trauma. BJOG: Int J Obstet Gynaecol. 2010;117(12):1485–92. https://doi.org/10.1111/j.1471-0528.2010.02704.x.

    Article  CAS  Google Scholar 

  23. Rogers RG, Leeman LM, Borders N, Qualls C, Fullilove AM, Teaf D, et al. Contribution of the second stage of labour to pelvic floor dysfunction: a prospective cohort comparison of nulliparous women. BJOG: Int J Obstet Gynaecol. 2014;121(9):1145–53; discussion 54. https://doi.org/10.1111/1471-0528.12571.

    Article  CAS  Google Scholar 

  24. Gosling JA, Dixon JS, Critchley HO, Thompson SA. A comparative study of the human external sphincter and periurethral levator ani muscles. British J Urol. 1981;53(1):35–41. https://doi.org/10.1111/j.1464-410x.1981.tb03125.x.

    Article  CAS  Google Scholar 

  25. Junginger B, Vollhaber H, Baessler K. Submaximal pelvic floor muscle contractions: similar bladder-neck elevation, longer duration, less intra-abdominal pressure. Int Urogynecol J. 2018;29(11):1681–7. https://doi.org/10.1007/s00192-018-3725-0.

    Article  PubMed  Google Scholar 

  26. Rosenbaum TY. Pelvic floor involvement in male and female sexual dysfunction and the role of pelvic floor rehabilitation in treatment: a literature review. J Sexual Med. 2007;4(1):4–13. https://doi.org/10.1111/j.1743-6109.2006.00393.x.

    Article  Google Scholar 

  27. Urbankova I, Grohregin K, Hanacek J, Krcmar M, Feyereisl J, Deprest J, et al. The effect of the first vaginal birth on pelvic floor anatomy and dysfunction. Int Urogynecol J. 2019;30(10):1689–96. https://doi.org/10.1007/s00192-019-04044-2.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Davidson MJ, Nielsen PMF, Taberner AJ, Kruger JA. Change in levator ani muscle stiffness and active force during pregnancy and post-partum. Int Urogynecol J. 2020;31(11):2345–51. https://doi.org/10.1007/s00192-020-04493-0.

    Article  PubMed  Google Scholar 

  29. Siff LN, Hill AJ, Walters SJ, Walters G, Walters MD. The effect of commonly performed exercises on the levator hiatus area and the length and strength of pelvic floor muscles in postpartum women. Female Pelvic Med Reconstruct Surg. 2020;26(1):61–6. https://doi.org/10.1097/spv.0000000000000590.

    Article  Google Scholar 

  30. Juez L, Núñez-Córdoba JM, Couso N, Aubá M, Alcázar JL, Mínguez J. Hypopressive technique versus pelvic floor muscle training for postpartum pelvic floor rehabilitation: A prospective cohort study. Neurourol Urodynam. 2019;38(7):1924–31. https://doi.org/10.1002/nau.24094.

    Article  Google Scholar 

  31. Wallace SL, Miller LD, Mishra K. Pelvic floor physical therapy in the treatment of pelvic floor dysfunction in women. Current Opinion Obstet Gynecol. 2019;31(6):485–93. https://doi.org/10.1097/gco.0000000000000584.

    Article  Google Scholar 

  32. Tennfjord MK, Engh ME, Bø K. The influence of early exercise postpartum on pelvic floor muscle function and prevalence of pelvic floor dysfunction 12 months postpartum. Phys Ther. 2020;100(9):1681–9. https://doi.org/10.1093/ptj/pzaa084.

    Article  PubMed  Google Scholar 

  33. Liu Z, Liu Y, Xu H, He L, Chen Y, Fu L, et al. Effect of electroacupuncture on urinary leakage among women with stress urinary incontinence: a randomized clinical trial. Jama. 2017;317(24):2493–501. https://doi.org/10.1001/jama.2017.7220.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

We are grateful for the support of several clinicians and midwives of Tongji Hospital for their help with patient recruitment.

Funding

This study was funded by Traditional Chinese Medicine for Maternal and Child Health Project of Shanghai, the National Natural Science Foundation of China (No. 81873827);Shanghai Municipal Health Commission Project (No. 201840304).

Author information

Authors and Affiliations

  1. Department of Gynecology and Obstetrics, Tongji Hospital, Tongji University School of Medicine, 389 Xincun Road, Shanghai, 200065, Putuo District, China

    Xia Jin, Siyu Wu, Juan Huang, Xiaowen Tong, Huaifang Li & Lei Chu

Authors
  1. Xia Jin
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  2. Siyu Wu
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  3. Juan Huang
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  4. Xiaowen Tong
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  5. Huaifang Li
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  6. Lei Chu
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Contributions

L Chu: Project development

HF Li: Project development

X Jin: Data collection

SY Wu: Data collection

J Huang: Data collection

L Chu: Management of data analysis

X Jin: Management of data analysis

L Chu: Manuscript writing

Corresponding author

Correspondence to Lei Chu.

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None.

Ethics approval

The study protocol was approved by the Ethics Committee of Tongji Hospital, Tongji University School of Medicine. Ethics Approval Number: KYSB-2018-13

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Jin, X., Wu, S., Huang, J. et al. Effect of prolonged second stage of labor on pelvic floor function: A prospective cohort study. Int Urogynecol J 33, 1633–1638 (2022). https://doi.org/10.1007/s00192-022-05136-2

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  • DOI: https://doi.org/10.1007/s00192-022-05136-2

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