Poster 28: The Effect of Genital Tract Trauma on Pelvic Floor Function After Childbirth

Abstract

OBJECTIVE: The objective of this study was to describe the impact of genital tract trauma on the prevalence of perineal pain, urinary (UI) and anal incontinence (AI), and sexual function in a low-risk cohort of women after vaginal birth. METHODS: In this prospective cohort study, women completed validated questionnaires at discharge, 6 weeks and 3 months postpartum. Questionnaires included the Modified McGill pain scale, Incontinence Impact Questionnaire (IIQ-7), Fecal Incontinence Score (FIS), and Intimate Relationship Scale (IRS). Intrapartum events were recorded and trauma was mapped to site (anterior or perineal) and severity (major or minor). Chi-squared analyses were used to compare subgroups. Significance was set at P<0.05. RESULTS: Five hundred thirteen women participated with follow-up rates of 96% postpartum day 1, 63% at 6 weeks, and 57% at 3 months. Mean age was 24.8 ± 5.2 years and 40% were nulliparous. Less than 1% of women underwent episiotomy or operative vaginal delivery or had recognized third- or fourth-degree lacerations. Twenty percent of women delivered without trauma, 34% with anterior (periurethral, periclitoral, or labial), 17% perineal, and 26%with both anterior and perineal trauma. Major trauma (trauma that involved perineal muscles or required suturing) occurred in 19%. At 3 months, few women (1%) had persistent perineal pain. AI (FIS score >0) was reported by 28% of women at 6 weeks and 24% at 3 months. Women with major trauma were more likely to report AI at 3 months (P=0.004), but presence or site of trauma was not related to AI complaints (all P=not significant [NS]). Complaints of UI were common at 28% at 6 weeks and 30% at 3 months. Fewer women reported IIQ-7 scores >0, at 17% and 12%, respectively. UI was not related to the presence or severity of trauma (all P=NS). Women with anterior trauma had fewer UI complaints than women with other sites of trauma (P=0.02). Dyspareunia was reported more often by women with major trauma than women with minor or no trauma (P=0.02). At 6 weeks, UI and AI were positively associated with directed forceful pushing in the second stage (P=0.003 and P=0.02, respectively). At 3 months, AI and UI were not associated with age, race/ethnicity, parity, body mass index, length of second stage, fetal weight, oxytocin or epidural use, or maternal position at delivery. CONCLUSIONS: This is the first prospective cohort study of low-risk healthy women that examines the impact of genital tract trauma on postpartum pelvic floor function. Complaints of pain were rare; AI and UI were reported more commonly. UI was inversely associated with anterior trauma, whereas AI was associated with perineal laceration. Directed forceful pushing in the second stage of labor may place women at risk in the short term for pelvic floor disorders.