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Birth trauma: short and long term effects of forceps delivery compared with spontaneous delivery on various pelvic floor parameters
Author(s) -
Meyer S.,
Hohlfeld P.,
Achtari C.,
Russolo A.,
Grandi P.
Publication year - 2000
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/j.1471-0528.2000.tb11648.x
Subject(s) - medicine , pelvic floor , forceps , vaginal delivery , incidence (geometry) , urinary incontinence , neck of urinary bladder , forceps delivery , stress incontinence , urethra , prospective cohort study , surgery , sphincter , urology , obstetrics , pregnancy , urinary bladder , genetics , physics , optics , biology
Objective To compare the effects of forceps delivery and spontaneous delivery on pelvic floor functions in nulliparous women. Design A longitudinal prospective study with investigations during the first pregnancy, 10 weeks and 10 months after delivery. Setting Antenatal clinic in a teaching hospital. Population One hundred and seven patients aged 28.4 years, divided into those with forceps ( n = 25 ) or spontaneous ( n = 82 ) delivery. Methods Investigations with a questionnaire, clinical examination, assessment of bladder neck behaviour, urethral sphincter function, intra‐vaginal/intra‐anal pressures during pelvic floor contractions. Results The incidence of stress urinary incontinence was similar in both groups at 9 weeks (32% vs 21%, P = 0.3 ) and 10 months (20% vs 15%, P = 0.6 ) after delivery, as was the incidence of faecal incontinence (9 weeks: 8% vs 4%, P = 0.9 ; 10 months: 4% vs 5%, P = 1 ) and the decreased sexual response at 10 months (12% vs 18%, P = 0.6 ). Bladder neck behaviour, urethral sphincter function and intra‐vaginal and intra‐anal pressures were also similar in the two groups. However, 10 months after delivery, the incidence of a weak pelvic floor (20% vs 6%, P = 0.05 ) and the decrease in intra‐anal pressure between the pre‐ and post‐delivery values (−17±28 cm H 2 O vs 3±31 cm H 2 O, P = 0.04 ) were significantly greater in the forceps‐delivered women. Conclusions Forceps delivery is not responsible for a higher incidence of pelvic floor complaints or greater changes in bladder neck behaviour or urethral sphincter functions. However, patients with forceps delivery have a significantly greater decrease in intra‐anal pressure and a greater incidence of a weak pelvic floor.