title: Long-term effects of vacuum extraction on pelvic floor function: a cohort study in primipara.
abstract: OBJECTIVE
  We describe the prevalence of symptomatic pelvic organ prolapse (sPOP), urinary incontinence (UI), fecal incontinence (FI) and obstetric anal sphincter injury (OASI) 20 years after one vacuum extraction (VE) delivery compared with one spontaneous vaginal delivery (SVD) or one acute caesarean section (ACS).
  
  
  METHODS
  We performed a register-based national cohort study of primipara who delivered between 1985 and 1988 and had no further deliveries. Medical Birth Register data were linked to data from postal questionnaires distributed 20 years after the birth (response rate 65.2 %, n = 5 236). Main outcome measures were prevalence and risk factors for pelvic floor disorders (PFDs) and OASI and their impact after VE compared with SVD and ACS. Multivariate logistic regression models were used.
  
  
  RESULTS
  The late prevalence of UI, sPOP, and FI was almost identical between VE and SVD. VE almost tripled the rate of OASI compared with SVD (6.3 vs. 2.4 %, p < 0.001). FI rate after an OASI was similar for both VE and SVD [30.2 vs. 27.8 %, adjusted odds ratio (aOR) 1.12; 95 % confidence interval (CI) 0.49-2.56]. Comparing VE without laceration with VE complicated by OASI increased the rate of FI (from 15.4 to 30.2 %, aOR 2.55; 95 % CI 1.26-5.15) and UI (from 39.0 to 61.4 %, aOR 2.28; 95 % CI 1.19-4.34), but the rate of sPOP was almost unaltered (from 15.0 to 15.9 %).
  
  
  CONCLUSIONS
  VE did not result in additional long-term PFDs provided the rate of OASI was similar to that after SVD. OASI after VE substantially increased the prevalence of FI and UI but did not alter the rate of sPOP.
authors.affiliation: Department of Obstetrics and Gynecology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.
authors.forename: Ida
authors.initials: I
authors.lastname: Nilsson
authors.affiliation: Department of Surgery, Södra Älvsborgs Hospital, Borås, Sweden.
authors.forename: Sigvard
authors.initials: S
authors.lastname: Åkervall
authors.affiliation: Department of Obstetrics and Gynecology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.
authors.forename: Ian
authors.initials: I
authors.lastname: Milsom
authors.affiliation: Department of Obstetrics and Gynecology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden. maria.gyhagen@vgregion.se.|Department of Obstetrics and Gynecology, Södra Älvsborgs Hospital, SE-501 82, Borås, Sweden. maria.gyhagen@vgregion.se.
authors.forename: Maria
authors.identifier: http://orcid.org/0000-0001-7355-8644
authors.initials: M
authors.lastname: Gyhagen
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000293:injuries; D015331:Cohort Studies; D005242:Fecal Incontinence / Q000201:enzymology / Q000209:etiology; D005260:Female; D006801:Humans; D010298:Parity; D059952:Pelvic Floor Disorders / Q000453:epidemiology / Q000209:etiology*; D056887:Pelvic Organ Prolapse / Q000453:epidemiology / Q000209:etiology; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D011247:Pregnancy; D015995:Prevalence; D013548:Sweden / Q000453:epidemiology; D014549:Urinary Incontinence / Q000453:epidemiology / Q000209:etiology; D014620:Vacuum Extraction, Obstetrical / Q000009:adverse effects*
keywords: Long-term effect; Obstetric sphincter injury; Pelvic floor disorders; Primipara; Vacuum extraction