title: Continuous recording of intrarectal pressures during the second phase of labour: correlations with postpartum pelvic floor complaints. A biomechanical-clinical study.
abstract: OBJECTIVE
  We correlated intrarectal pressure parameter recordings during the second phase of labour in primiparous women with postpartum pelvic floor (PF) complaints to try to define a critical pressure threshold for the occurrence of permanent PF injury.
  
  
  METHODS
  Using a microsystem device, the duration of bearing-down efforts, the area under the pressure curve and the peak pressure during bearing-down efforts were continuously recorded in 43 women with spontaneous delivery (group one) and in 17 women with forceps-assisted delivery (group two). PF complaints were assessed using ICS-validated questionnaires established before delivery and 14 ± 6 months after delivery.
  
  
  RESULTS
  Postpartum PF complaints were not significantly different between the groups. The first and second phases of labour were longer in women of group two. The three parameters measured were not correlated with the baby's weight or mode of delivery. The duration of bearing-down efforts was correlated with difficulty voiding and lower abdominal discomfort in women of group one only. The area under the pressure curve was correlated with feeling of urgency to void, urge incontinence, drops escape, decreased frequency of orgasm and difficulties in reaching orgasm in women of group two only. Peak pressure values were not correlated with any PF dysfunction.
  
  
  CONCLUSIONS
  Intrarectal pressure parameters during second phase of labour show no significant correlations with obstetric parameters, but were significantly correlated with some urinary and sexual PF complaints 14 months after spontaneous and forceps-assisted delivery with a higher incidence of significant correlations in women of group two with forceps-assisted delivery, probably because of the longer first and second phases of labour.
authors.affiliation: Gynecology & Obstetrics Department, Urogynecology Unit, CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland. sylvain.meyer@chuv.ch.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Meyer
authors.affiliation: Micro-Nanotechnology Department, Institute of Applied Sciences, Yverdon-les-Bains, Switzerland.
authors.forename: François
authors.initials: F
authors.lastname: Salchli
authors.affiliation: Gynecology & Obstetrics Department, CHUV, Lausanne, Switzerland.
authors.forename: Patrick
authors.initials: P
authors.lastname: Hohlfeld
authors.affiliation: Gynecology & Obstetrics Department, CHUV, Lausanne, Switzerland.
authors.forename: David
authors.initials: D
authors.lastname: Baud
authors.affiliation: Gynecology & Obstetrics Department, CHUV, Lausanne, Switzerland.
authors.forename: Yvan
authors.initials: Y
authors.lastname: Vial
authors.affiliation: Gynecology & Obstetrics Department, Urogynecology Unit, CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
authors.forename: Chahin
authors.initials: C
authors.lastname: Achtari
mesh_terms: D000328:Adult; D036861:Delivery, Obstetric / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007748:Labor Stage, Second / Q000502:physiology*; D008991:Monitoring, Physiologic / Q000379:methods; D009772:Obstetrical Forceps / Q000009:adverse effects; D010298:Parity / Q000502:physiology*; D017773:Pelvic Floor / Q000503:physiopathology; D059952:Pelvic Floor Disorders / Q000209:etiology*; D049590:Postpartum Period; D011247:Pregnancy; D011312:Pressure; D012007:Rectum / Q000502:physiology*
keywords: Delivery; Fecal incontinence; Intrarectal pressure recordings; Pelvic floor dysfunction; Sexual dysfunction; Urinary incontinence