Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The George Washington University School of Medicine and Health Sciences, Washington DC, USA.
Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Women's Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
J Matern Fetal Neonatal Med. 2022 Dec;35(25):5520-5525. doi: 10.1080/14767058.2021.1887122. Epub 2021 Feb 14.
Pelvic floor dysfunction is a group of disorders that can significantly impact quality of life due to persistent urinary and anal incontinence. Data evaluating the effect of prolonged second stage of labor and postpartum pelvic floor dysfunction is heterogenous and limited.
To evaluate whether extending the length of labor in nulliparous women with prolonged second stage affects the presence of self-reported pelvic floor dysfunction after a randomized controlled trial of prolonged second stage.
We conducted a planned follow up survey to our randomized controlled trial of prolonged second stage of labor using the Pelvic Floor Distress Inventory-20 (PFDI-20). The primary outcome was the PFDI-20 summary score. Secondary outcomes included urinary and fecal incontinence, prolapse, and patient satisfaction. Women surveyed were nulliparous patients with epidural anesthesia, previously enrolled in a randomized controlled trial that assigned them to , at least 1 additional hour in the second stage if they were undelivered after three hours, or to , defined as expedited delivery after three hours in the second stage. Women were surveyed at 12 - 36 months postpartum.
Thirty-four of the seventy-eight women responded to the survey (43.6%). 17 women (50.0%) were from the extended labor group and 17 from the usual labor group (50.0%). Maternal demographic data were not significantly different between groups. The PFDI-20 summary score was 13.8 ± 23.3 in the extended labor group and 13.1 ± 20.9 in the usual labor group ( = 0.9). The Pelvic Organ Prolapse Distress Inventory-6 was 1.2 ± 2.9 in the extended labor group and 2.7 ± 6.4 in the usual labor group ( = 0.4). The Colorectal-Anal Distress Inventory-8 was 0.8 ± 2.8 in the extended labor group and 2.1 ± 4.0 in the usual labor group ( = 0.6). The Urinary Distress Inventory-6 was 11.8 ± 21.1 in the extended labor group and 8.3 ± 14.5 in the usual labor group ( = 0.6). Maternal and neonatal outcomes, as well as patient satisfaction, were not statistically significantly different between groups.
Extending the length of labor in nulliparas with singleton gestations, epidural anesthesia, and prolonged second stage did not have an impact on PFDI-20 scores at 12-36 months postpartum. However, our study was underpowered to detect small, but potentially clinically important, differences.
NCT02101515 (Study Registration Date March 28, 2014) https://clinicaltrials.gov/ct2/show/NCT02101515.
盆底功能障碍是一组可导致持续性尿失禁和肛门失禁从而严重影响生活质量的疾病。评估第二产程延长与产后盆底功能障碍之间关系的数据存在差异且有限。
评估初产妇第二产程延长是否会影响随机对照试验（RCT）中第二产程延长后自我报告的盆底功能障碍。
我们对第二产程延长 RCT 进行了计划随访调查，使用盆底功能障碍问卷 20 项（PFDI-20）。主要结局是 PFDI-20 综合评分。次要结局包括尿失禁、粪失禁、脱垂和患者满意度。接受调查的妇女为接受硬膜外麻醉的初产妇，先前参加了一项 RCT，该 RCT 将她们随机分配至：至少在第三小时后再延长 1 小时的第二产程，或定义为第三小时后加速分娩的第二产程。妇女在产后 12-36 个月时接受调查。
在 78 名妇女中，有 34 名（43.6%）对调查做出了回应。17 名妇女（50.0%）来自延长劳动组，17 名妇女（50.0%）来自常规劳动组。两组产妇的人口统计学数据无显著差异。延长劳动组的 PFDI-20 综合评分为 13.8±23.3，常规劳动组为 13.1±20.9（ = 0.9）。延长劳动组的盆腔器官脱垂严重程度问卷-6 评分为 1.2±2.9，常规劳动组为 2.7±6.4（ = 0.4）。延长劳动组的肛肠窘迫问卷-8 评分为 0.8±2.8，常规劳动组为 2.1±4.0（ = 0.6）。延长劳动组的尿失禁严重程度问卷-6 评分为 11.8±21.1，常规劳动组为 8.3±14.5（ = 0.6）。两组产妇和新生儿结局以及患者满意度均无统计学差异。
在接受硬膜外麻醉和第二产程延长的单胎妊娠初产妇中延长产程，在产后 12-36 个月时不会影响 PFDI-20 评分。然而，我们的研究没有足够的能力来检测小但可能具有临床意义的差异。
NCT02101515（研究注册日期：2014 年 3 月 28 日）https://clinicaltrials.gov/ct2/show/NCT02101515。
