Prolonged second stage effect on pelvic floor dysfunction: a follow up survey to a randomized controlled trial

Area of Science:

• Obstetrics and Gynecology
• Pelvic Floor Disorders
• Maternal Health

Background:

• Pelvic floor dysfunction significantly affects quality of life through urinary and anal incontinence.
• Existing data on prolonged labor and postpartum pelvic floor dysfunction is limited and inconsistent.

Purpose of the Study:

• To assess if extending labor in nulliparous women with prolonged second stage influences self-reported pelvic floor dysfunction.
• To analyze the impact on urinary incontinence, fecal incontinence, and prolapse symptoms post-childbirth.

Main Methods:

• A planned follow-up survey of a randomized controlled trial on prolonged second stage of labor.
• Utilized the Pelvic Floor Distress Inventory-20 (PFDI-20) for primary outcome assessment.
• Surveyed nulliparous women with epidural anesthesia at 12-36 months postpartum, comparing extended labor (≥1 hour) versus usual labor protocols.

Main Results:

• No significant difference in PFDI-20 summary scores between extended labor (13.8 ± 23.3) and usual labor (13.1 ± 20.9) groups (p=0.9).
• Secondary outcomes including prolapse, colorectal-anal, and urinary distress scores also showed no significant differences between groups.
• Maternal demographics, neonatal outcomes, and patient satisfaction were comparable between the two labor management groups.

Conclusions:

• Extending labor duration in nulliparous women with prolonged second stage and epidural anesthesia did not affect PFDI-20 scores at 12-36 months postpartum.
• The study was underpowered to detect potentially clinically significant small differences.
• Further investigation with larger sample sizes is warranted to clarify the long-term effects of labor management on pelvic floor health.