title: Perineal body stretch during labor does not predict perineal laceration, postpartum incontinence, or postpartum sexual function: a cohort study.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Obstetrics & Gynecology, University of New Mexico, 2211 Lomas NE, 4th Floor, Albuquerque, NM, 87131, USA. kvmeri01@exchange.louisville.edu.|Department of Obstetrics & Gynecology, University of Louisville, 550 S. Jackson, Louisville, KY, 40202, USA. kvmeri01@exchange.louisville.edu.
authors.forename: Kate V
authors.initials: KV
authors.lastname: Meriwether
authors.affiliation: Department of Obstetrics & Gynecology, University of New Mexico, 2211 Lomas NE, 4th Floor, Albuquerque, NM, 87131, USA.
authors.forename: Rebecca G
authors.initials: RG
authors.lastname: Rogers
authors.affiliation: Department of Obstetrics & Gynecology, University of New Mexico, 2211 Lomas NE, 4th Floor, Albuquerque, NM, 87131, USA.
authors.forename: Gena C
authors.initials: GC
authors.lastname: Dunivan
authors.affiliation: Department of Obstetrics & Gynecology, University of New Mexico, 2211 Lomas NE, 4th Floor, Albuquerque, NM, 87131, USA.
authors.forename: Jill K
authors.initials: JK
authors.lastname: Alldredge
authors.affiliation: 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.
authors.forename: Clifford
authors.initials: C
authors.lastname: Qualls
authors.affiliation: Department of Obstetrics & Gynecology, University of New Mexico, 2211 Lomas NE, 4th Floor, Albuquerque, NM, 87131, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Migliaccio
authors.affiliation: Department of Obstetrics & Gynecology, University of New Mexico, 2211 Lomas NE, 4th Floor, Albuquerque, NM, 87131, USA.|Department of Family and Community Medicine, University of New Mexico, 2400 Tucker NE, Albuquerque, NM, 87131, USA.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Leeman
mesh_terms: D000328:Adult; D005242:Fecal Incontinence / Q000209:etiology / Q000473:pathology; D005260:Female; D006801:Humans; D007743:Labor, Obstetric / Q000502:physiology; D022125:Lacerations / Q000209:etiology* / Q000473:pathology; D007744:Obstetric Labor Complications / Q000473:pathology*; D010502:Perineum / Q000293:injuries / Q000473:pathology* / Q000503:physiopathology; D049590:Postpartum Period / Q000502:physiology; D011247:Pregnancy; D011446:Prospective Studies; D012735:Sexual Dysfunction, Physiological / Q000209:etiology* / Q000473:pathology; D011795:Surveys and Questionnaires; D014549:Urinary Incontinence / Q000209:etiology* / Q000473:pathology; D055815:Young Adult
keywords: Incontinence; Labor; Perineal body; Postpartum; Prolapse; Sexual function