Anal incontinence after a prolonged second stage of labor in primiparous women

Bergendahl, Sandra; Sandström, Anna; Spasojevic, Alexandra; Wendel, Sophia Brismar

doi:10.1038/s41598-022-11346-x

Cited by 5 publications

(6 citation statements)

References 46 publications

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“…A plausible explanation could be that PFD is dependent not only on OASI but also on other injuries. There was a trend for OASI mediating anal incontinence after VE at 4–5 h, as seen in our previous report 12 …”

Section: Discussionsupporting

confidence: 87%

“…There was a trend for OASI mediating anal incontinence after VE at 4-5 h, as seen in our previous report. 12 Intervention with CS avoids the passage of the fetus through the pelvic floor and thus some of the traumatic tissue injuries, although this was only observed if CS was performed at a second stage duration of 3-4 h. Pressure from the fetal head has been reported to contribute to PFD in women with CS during labour, 39,40 although this finding has been contradicted. 34 In our study, over 40% of the women with CS at second stage durations of 3-4 h and 4-5 h had a recorded fetal head station below the ischial spines, implying that the head could exert pressure on the surrounding tissues.…”

Section: Interpretation In Light Of Other Evidencementioning

confidence: 99%

“…A prolonged second stage has been associated with urinary incontinence, 7 particularly after prolonged pushing or operative vaginal delivery, 8,9 whereas other studies show no association. 10,11 Anal incontinence was unrelated to second stage duration in some reports, 11,12 but a prolonged second stage may lead to subsequent anal incontinence mediated by operative vaginal delivery and obstetric anal sphincter injury (OASI). 13 A prolonged second stage duration increases the risk of levator ani muscle injury, 14,15 which predisposes the development of pelvic organ prolapse (POP), 14,16 although POP has not been independently associated with second stage duration.…”

Section: Introductionmentioning

confidence: 99%

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Pelvic floor dysfunction after intervention, compared with expectant management, in prolonged second stage of labour: A population‐based questionnaire and cohort study

Bergendahl,

Sandström,

Zhao

et al. 2024

BJOG

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ObjectiveTo investigate the effect of vacuum extraction (VE) or caesarean section (CS), compared with expectant management, on pelvic floor dysfunction (PFD) 1–2 years postpartum in primiparous women with a prolonged second stage of labour.DesignA population‐based questionnaire and cohort study.SettingStockholm, Sweden.PopulationA cohort of 1302 primiparous women with a second stage duration of ≥3 h, delivering from December 2017 to November 2018.MethodsThe 1‐year follow‐up questionnaire from the Swedish National Perineal Laceration Register was distributed 12–24 months postpartum. Exposure was VE or CS at 3–4 h or 4–5 h, compared with expectant management.Main outcome measuresPelvic floor dysfunction was defined as at least weekly symptoms of urinary incontinence, pelvic organ prolapse or a Wexner score of ≥4. The risk of PFD was calculated using Poisson regression with robust variance estimation, presented as crude and adjusted relative risks (RRs and aRRs) with 95% confidence intervals (95% CIs). The implication of obstetric anal sphincter injury (OASI) on pelvic floor disorders was investigated through mediation analysis.ResultsIn total, 35.1% of women reported PFD. Compared with expectant management, the risk of PFD was increased after VE at 3–4 h (aRR 1.33, 95% CI 1.06–1.65) and 4–5 h (aRR 1.34, 95% CI 1.05–1.70), but remained unchanged after CS. The increased risk after VE was not mediated by OASI.ConclusionsPelvic floor dysfunction was common in primiparous women after a prolonged second stage, and the risk of PFD increased after VE but was unaffected by CS, compared with expectant management. If a spontaneous vaginal delivery eventually occurred, allowing an extended duration of labour did not increase the risk of PFD.

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Section: Discussionsupporting

confidence: 87%

Section: Interpretation In Light Of Other Evidencementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pelvic floor dysfunction after intervention, compared with expectant management, in prolonged second stage of labour: A population‐based questionnaire and cohort study

Bergendahl,

Sandström,

Zhao

et al. 2024

BJOG

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“…In addition to increased risk of operative delivery, prolonged labor is associated with chorioamnionitis [ 4 ], a negative birth experience [ 5 , 6 ], shoulder dystocia [ 7 ], low Apgar scores [ 7 ], and admission to the neonatal intensive care unit (NICU) [ 4 , 7 ]. There are also increased risks of severe postpartum hemorrhage [ 8 ], anal incontinence [ 9 ], urinary retention [ 10 ], hematomas [ 10 ], and ruptured sutures [ 10 ]. Hence, prolonged labor is a major clinical problem in obstetrics that needs to be identified and treated.…”

Section: Introductionmentioning

confidence: 99%

The effect of intravenous hyoscine butylbromide on slow progress in labor (BUSCLAB): A double-blind randomized placebo-controlled trial

Gaudernack,

Einarsen,

Sørbye

et al. 2024

PLoS Med

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Background Prolonged labor is a common condition associated with maternal and perinatal complications. The standard treatment with oxytocin for augmentation of labor increases the risk of adverse outcomes. Hyoscine butylbromide is a spasmolytic drug with few side effects shown to shorten labor when used in a general population of laboring women. However, research on its effect on preventing prolonged labor is lacking. We aimed to assess the effect of hyoscine butylbromide on the duration of labor in nulliparous women showing early signs of slow labor. Methods and findings In this double-blind randomized placebo-controlled trial, we included 249 nulliparous women at term with 1 fetus in cephalic presentation and spontaneous start of labor, showing early signs of prolonged labor by crossing the alert line of the World Health Organization (WHO) partograph. The trial was conducted at Oslo University Hospital in Norway from May 2019 to December 2021. One hundred and twenty-five participants were randomized to receive 1 ml hyoscine butylbromide (Buscopan) (20 mg/ml), while 124 received 1 ml sodium chloride intravenously. Randomization was computer-generated, with allocation concealment by opaque sequentially numbered sealed envelopes. The primary outcome was duration of labor from administration of the investigational medicinal product (IMP) to vaginal delivery, which was analyzed by Weibull regression to estimate the cause-specific hazard ratio (HR) of vaginal delivery between the 2 treatment groups, with associated 95% confidence interval (CI). A wide range of secondary maternal and perinatal outcomes were also evaluated. Time-to-event outcomes were analyzed by Weibull regression, whereas continuous and dichotomous outcomes were analyzed by median regression and logistic regression, respectively. All main analyses were based on the modified intention-to-treat (ITT) set of eligible women with signed informed consent receiving either of the 2 treatments. The follow-up period lasted during the postpartum hospital stay. All personnel, participants, and researchers were blinded to the treatment allocation. Median (mean) labor duration from IMP administration to vaginal delivery was 401 (440.8) min in the hyoscine butylbromide group versus 432.5 (453.6) min in the placebo group. We found no statistically significant association between IMP and duration of labor from IMP administration to vaginal delivery: cause-specific HR of 1.00 (95% CI [0.77, 1.29]; p = 0.993). Among 255 randomized women having received 1 dose of IMP, 169 women (66.3%) reported a mild adverse event: 75.2% in the hyoscine butylbromide group and 57.1% in the placebo group (Pearson’s chi-square test: p = 0.002). More than half of eligible women were not included in the study because they did not wish to participate or were not included upon admission. The participants might have represented a selected group of women reducing the external validity of the study. Conclusions One intravenous dose of 20 mg hyoscine butylbromide was not found to be superior to placebo in preventing slow labor progress in a population of first-time mothers at risk of prolonged labor. Further research is warranted to answer whether increased and/or repeated doses of hyoscine butylbromide might have an effect on duration of labor. Trial registration ClinicalTrials.gov (NCT03961165) EudraCT (2018-002338-19)

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“…Regarding long term the effects of the prolonged second stage, some studies describe associations with longer duration of the second stage and negative effects on the pelvic floor (82,83). Others found no associations for urinary incontinence (44,84) or other pelvic floor dysfunctions postpartum (44,(85)(86)(87)(88)(89)(90). However, all these studies lack a division between the passive and active second stage.…”

Section: Maternal Outcomesmentioning

confidence: 99%

Prolonged passive second stage of labour in nulliparous women: A multi perspective study

Bjelke

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Aim: This study aimed to describe the prolonged passive second stage of labour in nulliparous women in relation to its prevalence, risk factors, birth outcomes, midwives’ intrapartum management, and women's birth experiences. Methods: Study I was a qualitative study in which 36 midwives participated in seven focus group discussions. Data were analysed using qualitative content analysis. Studies II and III were retrospective observational cohort studies where medical records from 1131 nulliparous women in Sweden were reviewed. Analyses were performed using descriptive statistics and multivariable logistic regression. Study IV included 15 individual interviews with nulliparous women who had a passive second stage lasting three hours or more. Data were analysed using thematic analysis based on descriptive phenomenology. Results: Midwives’ management of the passive phase is complex, especially if progress is slow. Guidelines were considered, but women were preferably managed individually. The prevalence of prolonged passive second stage (≥2h) was 38%. Epidural analgesia, malpresentation, maternal age ≥30 years, and birth weight of ≥4 kg were identified as risk factors for prolonged passive second stage. Longer duration of the passive second stage was associated with an increased risk of operative delivery. There were no associations with adverse maternal outcomes. Associations with adverse neonatal outcomes were found, although the rate of adverse neonatal outcomes were low in the study population. Women’s experiences of prolonged passive second stage were described in four themes: “An unknown phase”, “Trust and mistrust in the body’s ability”, ”Loss of control“, and “Support through presence and involvement”. Conclusion: This thesis describes the prolonged passive second stage from multiple perspectives, including midwives, epidemiological data, and women’s experiences. The midwives’ management of the passive second stage included a complex continuous process of assessment and balancing options for the next step. A prolonged passive second stage was common and did not result in increased risks of adverse maternal outcomes, although further fetal surveillance can be called for. Nulliparous women experienced the passive second stage as an unknown phase and expected a different path for birth, and the experience could include loss of control and increased need for emotional and physical support.

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Anal incontinence after a prolonged second stage of labor in primiparous women

Cited by 5 publications

References 46 publications

Pelvic floor dysfunction after intervention, compared with expectant management, in prolonged second stage of labour: A population‐based questionnaire and cohort study

Pelvic floor dysfunction after intervention, compared with expectant management, in prolonged second stage of labour: A population‐based questionnaire and cohort study

The effect of intravenous hyoscine butylbromide on slow progress in labor (BUSCLAB): A double-blind randomized placebo-controlled trial

Prolonged passive second stage of labour in nulliparous women: A multi perspective study

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