Impact of Labor Duration on Pelvic Symptoms in Women Randomized to Immediate Vs Delayed Pushing

Thursday, October 5, 2023

11:14 AM – 11:18 AM US PST

Location: B113-116

Click to View Image
Image Label: Table 1: Peripartum characteristics at 1-5 days postpartum

Click to View Image
Image Label: Table 2: Pelvic floor assessments at baseline (1-5 days postpartum) and 6 months

Presenting Author(s)

Collin M. McKenzie, MD

FPMRS Fellow
The University of Texas at Austin
Pflugerville, Texas, United States

PDF

Co-Author(s)

CW

Candice L. Woolfolk, PhD, MPH

Assistant Professor
Washington University School of Medicine Department of Obstetrics & Gynecology
St Louis, Missouri, United States
MR

Mary M. Rieger, MD, MAS (she/her/hers)

Assistant Professor
Dell Medical School at The University of Texas at Austin
Austin, Texas, United States
AW

Amanda B. White, MD

Associate Professor
UT Austin Dell Medical School
Austin, Texas, United States
LC

Lauren Caldwell, MD (she/her/hers)

Assistant Professor
University of Texas at Austin Dell Medical School
Austin, Texas, United States
LK

Laura Kent, MD (she/her/hers)

Urogynecology Fellow
The University of Texas at Austin Dell Medical School
Austin, Texas, United States
MT

Methodius R. Tuuli, MD, MPH, MBA

Professor and Chair
Warren Alpert Medical School at Brown University
Providence, Rhode Island, United States
SS

Sindhu Srinivas, MD, MSCE

Professor
Penn Medicine Perelman School of Medicine
Philadelphia, Pennsylvania, United States
AC

Aaron B. Caughey, MD, MPH, PhD (he/him/his)

Professor and Chair
Oregon Health & Science University
Portland, Oregon, United States
AT

Alan Tita, MD, PhD

Professor
UAB
Birmingham, AL, Alabama, United States
W. Thomas Gregory, MD (he/him/his)

Professor
Oregon Health & Science University
Portland, Oregon, United States
Holly E. Richter, PhD, MD

Professor of Obstetrics and Gynecology, Urology and Geriatrics
University of Alabama at Birmingham
Birmingham, Alabama, United States
AC

Alison Cahill, MD

Professor, Department of Women's Health
University of Texas at Austin, Dell Medical School
Austin, Texas, United States

Disclosure(s):

Collin M. McKenzie, MD: No financial relationships to disclose

Candice L. Woolfolk, PhD, MPH: No financial relationships to disclose

Mary M. Rieger, MD, MAS: No financial relationships to disclose

Amanda B. White, MD: Boston Scientific: Consultant/Advisory Board (Ongoing)

Lauren Caldwell, MD: No financial relationships to disclose

Laura Kent, MD: No financial relationships to disclose

Methodius R. Tuuli, MD, MPH, MBA: No financial relationships to disclose

Sindhu Srinivas, MD, MSCE: No financial relationships to disclose

Aaron B. Caughey, MD, MPH, PhD: No financial relationships to disclose

Alan Tita, MD, PhD: Pfizer: Clinical Trial Investigator (Ongoing)

W. Thomas Gregory, MD: No financial relationships to disclose

Holly E. Richter, PhD, MD: Allergan: Clinical Trial Investigator (Terminated, January 28, 2022); BlueWind Medical: DSMB Member (Ongoing); Coloplast: Consultant/Advisory Board (Ongoing); COSM: Consultant/Advisory Board (Ongoing); EBT Medical: Clinical Trial Investigator (Terminated, December 31, 2022); Laborie: Consultant/Advisory Board (Ongoing); Neomedic: Consultant/Advisory Board (Ongoing); Palette Life Science: Consultant/Advisory Board (Ongoing); Reia LLC: Clinical Trial Investigator (Ongoing); Renovia: Clinical Trial Investigator (Ongoing)

Alison Cahill, MD: No financial relationships to disclose

Objectives: To examine the association between duration of second stage of labor (SSL) and pelvic floor symptoms at 6 months postpartum among primiparas.

Methods: This was a planned secondary analysis of a multicenter randomized trial conducted between 2014 and 2018 evaluating the impact of immediate versus delayed pushing on vaginal delivery rates, maternal morbidity, and neonatal outcomes (N=2414). For participants who elected to participate in the pelvic floor arm, baseline data, including demographics, pelvic organ prolapse quantification (POP-Q) examination, and validated questionnaire data, was collected at 1-5 days postpartum. The primary outcome of this study was change in Pelvic Floor Distress Inventory-20 (PFDI-20) score from baseline to 6 months postpartum. Secondary outcomes included changes in the Pelvic Floor Impact Questionnaire (PFIQ-7), Fecal Incontinence Severity Index (FISI), Modified Manchester Health Questionnaire (MMHQ) scores and POP-Q measurements at 6 months postpartum. Participants were analyzed by SSL duration ≤60 minutes or >60 minutes based on median duration of SSL among nulliparas from the Consortium of Safe Labor.

Results: Of the 2414 trial participants, 767 (32%) completed pelvic floor assessments at 6 months. Women with a shorter SSL, ≤60 minutes, were more likely to be younger, Black, and have neonate with a lower weight. Women with a longer SSL, >60 minutes, were more likely to undergo operative vaginal or cesarean delivery and have second- or third-degree perineal laceration (Table 1). PFDI-20 scores significantly improved at 6 months in the shorter SSL group compared with longer SSL (-14.3±48.0, -3.2±45.3, respectively, P=.04). Changes from baseline in total and subscale scores for the PFIQ-7, FISI, and MMHQ at 6 months did not differ between groups (Table 2). Prolapse stage did not differ between groups at 6 months (Table 1). Perineal body was significantly shorter in the prolonged SSL group at 6 months (3.7±0.7, 3.5±0.8, P=.03).

Conclusions: Women with prolonged SSL experience less improvement in PFDI-20 scores at 6 months. Likewise, prolonged SSL was associated with higher rates of second- and third-degree perineal lacerations, and operative vaginal or cesarean deliveries. Greater tissue and innervation trauma in those with SSL longer than 60 minutes may explain persistently less improvement in PFDI-20 scores.