Three-Year Outcomes of Second-Stage Pushing Timing on Postpartum Pelvic Floor Morbidity.

OBJECTIVE

To compare the long-term pelvic floor subjective and objective outcomes of immediate and delayed pushing in the second stage of labor.

METHODS

This was a multicenter randomized controlled trial that included nulliparous patients at 37 weeks of gestation or more in labor with neuraxial analgesia. Participants were randomized in the second stage of labor to immediate pushing or pushing after a 60-minute delay. Pelvic floor assessments were performed 1-5 days, 4-8 weeks, and 2-3 years postpartum. Pelvic organ prolapse quantification (POP-Q) measurements and validated questionnaire score (PFDI-20 [Pelvic Floor Distress Inventory], PFIQ-7 [Pelvic Floor Impact Questionnaire], FISI [Fecal Incontinence Severity Index], and MMHQ [Modified Manchester Health Questionnaire]) assessments were compared within and between the immediate and delayed pushing groups. Pelvic floor questionnaire assessments were performed 1-5 days and 2-3 years postpartum. The POP-Q examinations were performed at 4-8 weeks and 2-3 years postpartum. Changes in questionnaire scores were adjusted for birth weight exceeding 4,000 g and duration of pushing.

RESULTS

A total of 2,414 participants were randomized between 2014 and 2017. Three hundred fifty-six women (14.7%) completed pelvic floor assessments at 2-3 years, 175 in the immediate pushing group and 181 in the delayed pushing group. Patients with an interval pregnancy were excluded (n=236). There was no significant difference in POP-Q stage at 2-3 years postpartum. Intergroup and intragroup changes in total and subscale scores for the PFIQ, FISI, and MMHQ were not significantly different at 2-3 years postpartum (-12.8±47.2 vs -22.0±58.7, P =.09; -1.2±8.0 vs -0.6±7.7, P =.56; and 3.1±22.5 vs -0.1±20.2, P =.53, respectively). The changes in PFDI-20 score were not significantly different (3.4±29.1 vs 0.4±36.2, P=.40). However, the Colorectal-Anal Distress Inventory subscale score change was significantly different (2.4±16.0 vs -5.7±15.7, P =.01).

CONCLUSION

Among nulliparous patients in the second stage of labor with neuraxial analgesia, immediate compared with delayed pushing did not result in significant differences in POP-Q measures and most pelvic floor symptoms at 2-3 years.

CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov , NCT02137200.