Department of Urogynaecology, National Maternity Hospital, Dublin, Ireland (Drs Bobby D. O'Leary and Declan P. Keane); UCD Perinatal Research Centre, National Maternity Hospital, Dublin, Ireland (Dr. Bobby D. O'Leary).
Department of Urogynaecology, National Maternity Hospital, Dublin, Ireland (Drs Bobby D. O'Leary and Declan P. Keane); Royal College of Surgeons in Ireland, National Maternity Hospital, Dublin, Ireland (Dr. Declan P. Keane).
Am J Obstet Gynecol MFM. 2023 Feb;5(2):100795. doi: 10.1016/j.ajogmf.2022.100795. Epub 2022 Nov 2.
Pelvic floor dysfunction refers to any combination of incontinence, overactive bladder, pelvic organ prolapse, and sexual dysfunction. Pelvic floor dysfunction affects approximately 25% to 30% of women and is linked to parity and age. Some obstetrical 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 the rates of cesarean delivery in nulliparous women, though it has also been linked to pelvic floor injuries.
This study aimed to determine the effect of the length of the second stage of labor on self-reported pelvic floor dysfunction.
This was a single-center prospective cohort study in a tertiary referral obstetrical unit. Nulliparous women attending routine antenatal clinics were recruited to complete the Australian Pelvic Floor Questionnaire during pregnancy and again 3 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 analyzed 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. The secondary outcomes included the comparison of maternal, obstetrical, and functional pelvic floor outcomes based on the mode of delivery and the length of the second stage of labor.
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, whereas maternal age was protective. Compared with those with 60 to 120 minutes or <60 minutes of second stage of labor, women with that longer than 120 minutes had higher rates of stress incontinence (85.7% [>120 minutes] vs 41.7% [60-120 minutes] or 52.5% [<60 minutes], P=.001), urinary urgency (89.3% [>120 minutes] vs 39.6% [60-120 minutes] or 53.8% [<60 minutes], P<.001), and fecal incontinence (10.7% [>120 minutes] vs 0% [60-120 minutes] or 1.2% [<60 minutes], P=.027). There were no differences in the rates of sexual activity or dyspareunia. Women delivering vaginally had higher rates of stress incontinence (57.6% vs 38.0%, P=.006) than those undergoing cesarean delivery, though there were no differences in other pelvic floor symptoms or pelvic floor scores.
A prolonged second stage of labor is associated with more self-reported bladder dysfunction at 3 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.
盆底功能障碍是指尿失禁、膀胱过度活动症、盆腔器官脱垂和性功能障碍的任意组合。盆底功能障碍影响约 25%至 30%的女性，与生育次数和年龄有关。已经强调了一些产科危险因素，但第二产程尚未得到充分研究。有人建议延长第二产程以降低初产妇剖宫产率，尽管这也与盆底损伤有关。
本研究旨在确定第二产程的长短对自我报告的盆底功能障碍的影响。
这是一项在三级转诊产科单位进行的单中心前瞻性队列研究。招募常规产前门诊就诊的初产妇在怀孕期间和分娩后 3 个月完成澳大利亚盆底问卷。本研究的主要结局是使用多元回归分析第二产程长短对总盆底评分的影响。模型调整了母亲的年龄、母亲的体重指数、第二产程长度、胎儿出生体重、分娩方式和会阴创伤。次要结局包括根据分娩方式和第二产程长度比较产妇、产科和功能盆底结局。
在 295 名入组的妇女中，第二产程长度和体重指数与多变量回归分析中的膀胱功能障碍有关，而母亲年龄具有保护作用。与第二产程 60-120 分钟或<60 分钟的妇女相比，第二产程超过 120 分钟的妇女更易出现压力性尿失禁（85.7%[>120 分钟]比 41.7%[60-120 分钟]或 52.5% [<60 分钟]，P=.001）、尿急（89.3%[>120 分钟]比 39.6%[60-120 分钟]或 53.8% [<60 分钟]，P<.001）和粪便失禁（10.7%[>120 分钟]比 0%[60-120 分钟]或 1.2% [<60 分钟]，P=.027）。性行为或性交痛的发生率没有差异。阴道分娩的妇女压力性尿失禁发生率（57.6%比 38.0%，P=.006）高于剖宫产的妇女，但其他盆底症状或盆底评分无差异。
初产妇第二产程延长与产后 3 个月自我报告的膀胱功能障碍增多有关。第二产程较长的妇女应被告知短期膀胱功能障碍的风险，尽管长期后遗症的发生率尚不清楚。
