title: Birth trauma: short and long term effects of forceps delivery compared with spontaneous delivery on various pelvic floor parameters.
abstract: OBJECTIVE
  To compare the effects of forceps delivery and spontaneous delivery on pelvic floor functions in nulliparous women.
  
  
  METHODS
  A longitudinal prospective study with investigations during the first pregnancy, 10 weeks and 10 months after delivery.
  
  
  METHODS
  Antenatal clinic in a teaching hospital.
  
  
  METHODS
  One hundred and seven patients aged 28 +/- 4 years, divided into those with forceps (n = 25) or spontaneous (n = 82) delivery.
  
  
  METHODS
  Investigations with a questionnaire, clinical examination, assessment of bladder neck behaviour, urethral sphincter function, intra-vaginal/intra-anal pressures during pelvic floor contractions.
  
  
  RESULTS
  The incidence of stress urinary incontinence was similar in both groups at 9 weeks (32% vs 21%, P = 0.3) and 10 months (20% vs 15%, P = 0.6) after delivery, as was the incidence of faecal incontinence (9 weeks: 8% vs 4%, P = 0.9; 10 months: 4% vs 5%, P = 1) and the decreased sexual response at 10 months (12% vs 18%, P = 0.6). Bladder neck behaviour, urethral sphincter function and intra-vaginal and intra-anal pressures were also similar in the two groups. However, 10 months after delivery, the incidence of a weak pelvic floor (20% vs 6%, P = 0.05) and the decrease in intra-anal pressure between the pre- and post-delivery values (-17 +/- 28 cm H2O vs 3 +/- 31 cm H2O, P = 0.04) were significantly greater in the forceps-delivered women.
  
  
  CONCLUSIONS
  Forceps delivery is not responsible for a higher incidence of pelvic floor complaints or greater changes in bladder neck behaviour or urethral sphincter functions. However, patients with forceps delivery have a significantly greater decrease in intra-anal pressure and a greater incidence of a weak pelvic floor.
authors: Department of Gynecology and Obstetrics, CHUV, Lausanne, Switzerland.
authors: S
authors: S
authors: Meyer
authors: P
authors: P
authors: Hohlfeld
authors: C
authors: C
authors: Achtari
authors: A
authors: A
authors: Russolo
authors: P
authors: P
authors: De Grandi
mesh_terms: D000328:Adult; D001004:Anus Diseases / Q000209:etiology* / Q000503:physiopathology; D015331:Cohort Studies; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D007744:Obstetric Labor Complications / Q000209:etiology* / Q000503:physiopathology; D009772:Obstetrical Forceps / Q000009:adverse effects*; D017773:Pelvic Floor / Q000502:physiology; D011247:Pregnancy; D011312:Pressure; D011446:Prospective Studies; D014522:Urethral Diseases / Q000209:etiology* / Q000503:physiopathology; D014550:Urinary Incontinence, Stress / Q000209:etiology