Kate V Meriwether1,2, Rebecca G Rogers3, Gena C Dunivan3, Jill K Alldredge3, Clifford Qualls4, Laura Migliaccio3, Lawrence Leeman3,5. 1. Department of Obstetrics & Gynecology, University of New Mexico, 2211 Lomas NE, 4th Floor, Albuquerque, NM, 87131, USA. kvmeri01@exchange.louisville.edu. 2. Department of Obstetrics & Gynecology, University of Louisville, 550 S. Jackson, Louisville, KY, 40202, USA. kvmeri01@exchange.louisville.edu. 3. Department of Obstetrics & Gynecology, University of New Mexico, 2211 Lomas NE, 4th Floor, Albuquerque, NM, 87131, USA. 4. Department of Biostatistics, Multidisciplinary Research Facility, Clinical Sciences and Translational Center, University of New Mexico, 2705 Frontier Ave., First Floor, Room 120, Albuquerque, NM, 87131, USA. 5. Department of Family and Community Medicine, University of New Mexico, 2400 Tucker NE, Albuquerque, NM, 87131, USA.
Abstract
INTRODUCTION AND HYPOTHESIS: The perineum stretches naturally during obstetrical labor, but it is unknown whether this stretch has a negative impact on pelvic floor outcomes after a vaginal birth (VB). We aimed to evaluate whether perineal stretch was associated with postpartum pelvic floor dysfunction, and we hypothesized that greater perineal stretch would correlate with worsened outcomes. METHODS: This was a prospective cohort study of primiparous women who had a VB. Perineal body (PB) length was measured antepartum, during labor, and 6 months postpartum. We determined the maximum PB (PBmax) measurements during the second stage of labor and PB change (ΔPB) between time points. Women completed functional questionnaires and had a Pelvic Organ Prolapse Quantification (POP-Q) system exam 6 months postpartum. We analyzed the relationship of PB measurements to perineal lacerations and postpartum outcomes, including urinary, anal, and fecal incontinence, sexual activity and function, and POP-Q measurements. RESULTS: Four hundred and forty-eight women with VB and a mean age of 24 ± 5.0 years with rare (5 %) third- or fourth-degree lacerations were assessed. During the second stage of labor, 270/448 (60 %) had perineal measurements. Mean antepartum PB length was 3.7 ± 0.8 cm, with a maximum mean PB length (PBmax) during the second stage of 6.1 ± 1.5 cm, an increase of 65 %. The change in PB length (ΔPB) from antepartum to 6 months postpartum was a net decrease (-0.39 ± 1.02 cm). PB change and PBmax were not associated with perineal lacerations or outcomes postpartum (all p > 0.05). CONCLUSIONS: PB stretch during labor is unrelated to perineal laceration, postpartum incontinence, sexual activity, or sexual function.
INTRODUCTION AND HYPOTHESIS: The perineum stretches naturally during obstetrical labor, but it is unknown whether this stretch has a negative impact on pelvic floor outcomes after a vaginal birth (VB). We aimed to evaluate whether perineal stretch was associated with postpartum pelvic floor dysfunction, and we hypothesized that greater perineal stretch would correlate with worsened outcomes. METHODS: This was a prospective cohort study of primiparous women who had a VB. Perineal body (PB) length was measured antepartum, during labor, and 6 months postpartum. We determined the maximum PB (PBmax) measurements during the second stage of labor and PB change (ΔPB) between time points. Women completed functional questionnaires and had a Pelvic Organ Prolapse Quantification (POP-Q) system exam 6 months postpartum. We analyzed the relationship of PB measurements to perineal lacerations and postpartum outcomes, including urinary, anal, and fecal incontinence, sexual activity and function, and POP-Q measurements. RESULTS: Four hundred and forty-eight women with VB and a mean age of 24 ± 5.0 years with rare (5 %) third- or fourth-degree lacerations were assessed. During the second stage of labor, 270/448 (60 %) had perineal measurements. Mean antepartum PB length was 3.7 ± 0.8 cm, with a maximum mean PB length (PBmax) during the second stage of 6.1 ± 1.5 cm, an increase of 65 %. The change in PB length (ΔPB) from antepartum to 6 months postpartum was a net decrease (-0.39 ± 1.02 cm). PB change and PBmax were not associated with perineal lacerations or outcomes postpartum (all p > 0.05). CONCLUSIONS:PB stretch during labor is unrelated to perineal laceration, postpartum incontinence, sexual activity, or sexual function.
Entities:
Keywords:
Incontinence; Labor; Perineal body; Postpartum; Prolapse; Sexual function
Authors: R C Bump; A Mattiasson; K Bø; L P Brubaker; J O DeLancey; P Klarskov; B L Shull; A R Smith Journal: Am J Obstet Gynecol Date: 1996-07 Impact factor: 8.661
Authors: Kate V Meriwether; Rebecca J Hall; Lawrence M Leeman; Laura Migliaccio; Clifford Qualls; Rebecca G Rogers Journal: Int Urogynecol J Date: 2013-10-09 Impact factor: 2.894
Authors: Janis M Miller; Lisa Kane Low; Ruth Zielinski; Abigail R Smith; John O L DeLancey; Catherine Brandon Journal: Am J Obstet Gynecol Date: 2015-05-05 Impact factor: 8.661
Authors: Annette J Reid; Andrew D Beggs; Abdul H Sultan; Anne-Marie Roos; Ranee Thakar Journal: Int J Gynaecol Obstet Date: 2014-06-12 Impact factor: 3.561