Pelvic floor morbidity up to one year after difficult instrumental delivery and cesarean section in the second stage of labor: a cohort study.
OBJECTIVE
This study was undertaken to assess symptoms of pelvic floor morbidity at 6 weeks and at 1 year after difficult instrumental vaginal delivery or cesarean section during the second stage of labor.


METHODS
Prospective cohort study of 393 women with term, singleton, cephalic pregnancies who required operative delivery in surgery at full dilatation between February 1999 and February 2000. Postal questionnaires were used for follow-up at 6 weeks and at 1 year.


RESULTS
Instrumental delivery was associated with a greater risk of urinary incontinence at 6 weeks and at 1-year postdelivery, adjusted odds ratio [OR] 7.8 (95% CI, 2.6-23.6) and OR 3.1 (95% CI, 1.3-7.6), respectively. Although instrumental delivery was associated with an increased risk of moderate-to-severe dyspareunia at 6 weeks, adjusted OR 3.35 (95% CI, 1.36-8.25), this difference was not significant at 1 year. Cesarean section after attempted instrumental delivery was associated with an increased risk of moderate-to-severe pain during intercourse at 1 year compared with immediate cesarean section, (18% vs 9%) P=.01.


CONCLUSIONS
Although cesarean section at full dilatation does not completely protect women from pelvic floor morbidity, those that followed instrumental delivery had a significantly greater prevalence of urinary symptoms and dyspareunia. Urinary symptoms persist up to 1 year after delivery.
Liebling
Rachel E
RE
Royal United Hospital, Bath, UK. reliebling@hotmail.com
Swingler
Rebecca
R
Patel
Roshni R
RR
Verity
Lisa
L
Soothill
Peter W
PW
Murphy
Deirdre J
DJ
D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D005113:Extraction, Obstetrical / Q000009:adverse effects*; D005242:Fecal Incontinence / Q000209:etiology*; D005260:Female; D006801:Humans; D007748:Labor Stage, Second; D016015:Logistic Models; D011247:Pregnancy; D011446:Prospective Studies; D012725:Sexual Behavior; D014219:Trial of Labor; D014549:Urinary Incontinence / Q000209:etiology*