Skip to main content

Advertisement

SpringerLink
Log in

Too tight to give birth? Assessment of pelvic floor muscle function in 277 nulliparous pregnant women

  • Original Article
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

Abstract

Introduction and hypothesis

Theoretically, tight or strong pelvic floor muscles may impair the progress of labor and lead to instrumental deliveries. We aimed to investigate whether vaginal resting pressure, pelvic floor muscle strength, or endurance at midpregnancy affect delivery outcome.

Methods

This was a prospective cohort study of women giving birth at a university hospital. Vaginal resting pressure, pelvic floor muscle strength, and endurance in 300 nulliparous pregnant women were assessed at mean gestational week 20.8 (±1.4) using a high precision pressure transducer connected to a vaginal balloon. Delivery outcome measures [acute cesarean section, prolonged second stage of labor (> 2 h), instrumental vaginal delivery (vacuum and forceps), episiotomy, and third- and fourth-degree perineal tear) were retrieved from the hospital’s electronic birth records.

Results

Twenty-three women were lost to follow-up, mostly because they gave birth at another hospital. Women with prolonged second stage had significantly higher resting pressure than women with second stage less than 2 h; the mean difference was 4.4 cmH2O [95 % confidence interval (CI) 1.2–7.6], p < 0.01, adjusted odds ratio 1.049 (95 % CI 1.011–1.089, p = 0.012). Vaginal resting pressure did not affect other delivery outcomes. Pelvic floor muscle strength and endurance similarly were not associated with any delivery outcomes.

Conclusions

While midpregnancy vaginal resting pressure is associated with prolonged second stage of labor, neither vaginal resting pressure nor pelvic floor muscle strength or endurance are associated with operative delivery or perineal tears. Strong pelvic floor muscles are not disadvantageous for vaginal delivery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Boyle R, Hay-Smith EJC, Cody JD, Mørkved S (2012) Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database Syst Rev 10: CD007471. doi:10.1002/14651858.CD007471.pub2

  2. Artal R, Buckenmeyer PJ (1995) Exercise during pregnancy and postpartum. Contemp Obstet Gynecol 40:62–90

    Google Scholar 

  3. Kruger JA, Dietz HP, Murphy BA (2007) Pelvic floor function in elite nulliparous athletes. Ultrasound Obstet Gynecol 30:81–85

    Article  PubMed  CAS  Google Scholar 

  4. Nielsen CA, Sigsgaaard I, Olsen M, Tolstrup M, Danneskiold-Samsoee B, Bock JE (1988) Trainability of the pelvic floor. A prospective study during pregnancy and after delivery. Acta Obstet Gynecol Scand 67:437–440

    Article  PubMed  CAS  Google Scholar 

  5. Salvesen KA, Mørkved S (2004) Randomised controlled trial of pelvic floor muscle training during pregnancy. BMJ 329:378–380

    Article  PubMed  Google Scholar 

  6. Agur W, Steggels P, Waterfield M, Freeman R (2008) Does antenatal pelvic floor muscle training affect outcome of labour? A randomised controlled trial. Int Urogynecol J Pelvic Floor Dysfunct 19:85–88

    PubMed  Google Scholar 

  7. Bø K, Fleten C, Nystad W (2009) Effect of antenatal pelvic floor muscle training on labor and birth. Obstet Gynecol 113:1279–1284

    PubMed  Google Scholar 

  8. Gorbea Chávez V, Velázques Sánchez MP, Kunhardt Rasch JR (2004) Effect of pelvic floor exercise during pregnancy and puerperium on prevention of urinary stress incontinence. Ginecol Obstet Mex 72:628–636

    PubMed  Google Scholar 

  9. Bø K, Kvarstein B, Hagen R, Larsen S (1990) Pelvic floor muscle exercise for the treatment of female stress urinary incontinence: II. Validity of vaginal pressure measurements of pelvic floor muscle strength and the necessity of supplementary methods for control of correct contraction. Neurourol Urodyn 9:479–487

    Article  Google Scholar 

  10. Bø K, Kvarstein B, Hagen R, Oseid S, Larsen S (1990) Pelvic floor muscle exercise for the treatment of female stress urinary incontinence: I. Reliability of vaginal pressure measurements of pelvic floor muscle strength. Neurourol Urodyn 9:471–477

    Article  Google Scholar 

  11. Bø K (1992) Pressure measurements during pelvic floor muscle contractions: the effect of different positions of the vaginal measuring device. Neurourol Urodyn 11:107–113

    Article  Google Scholar 

  12. Braekken IH, Majida M, Engh ME, Bø K (2009) Pelvic floor function is independently associated with pelvic organ prolapse. BJOG 116:1706–1714

    Article  PubMed  CAS  Google Scholar 

  13. American College of Obstetrics and Gynecology Committee on Practice Bulletins-Obstetrics (2003) ACOG Practice Bulletin Number 49, December 2003: dystocia and augmentation of labor. Obstet Gynecol 102:1445–1454

    Article  Google Scholar 

  14. NICE clinical guideline 55. Intrapartum care. Care of healthy women and their babies during childbirth. September 2007. www.nice.org.uk/cg55

  15. Sultan AH, Kamm MA, Bartram CI, Hudson CN (1994) Perineal damage at delivery. Contemp Rev Obstet Gynaecol 6:18–24

    Google Scholar 

  16. Elenskaia K, Thakar R, Sultan AH, Scheer I, Beggs A (2011) The effect of pregnancy and childbirth on pelvic floor muscle function. Int Urogynecol J 22:1421–1427

    Article  PubMed  Google Scholar 

  17. Dias LAR, Driusso P, Aita DLC, Quintana SM, Bø K, Ferreira CH (2011) Effect of pelvic floor muscle training on labour and newborn outcomes: a randomized controlled trial. Rev Bras Fisioter 15:487–493

    Article  PubMed  Google Scholar 

  18. Mørkved S, Salvesen KÅ, Bø K, Eik-Nes S (2004) Pelvic floor muscle strength and thickness in continent and incontinent nulliparous pregnant women. Int Urogynecol J Pelvic Floor Dysfunct 15:384–390

    Article  PubMed  Google Scholar 

  19. Brækken IH, Majida M, Ellstrøm Engh M, Bø K (2013) Are pelvic floor muscle thickness and size of levator hiatus associated with pelvic floor muscle strength, endurance and vaginal resting pressure in women with pelvic organ prolapse stages I- III. A cross sectional 3D ultrasound study. Neurourol Urodyn. doi:10.1002/nau.22384

  20. Aran T, Osmanagaoglu MA, Kart C, Guven S, Sahin M, Unsal MA (2012) Failed labor induction in nulliparous women at term: the role of pelvic floor muscle strength. Int Urogynecol J 23:1105–1110

    Article  PubMed  Google Scholar 

  21. Shek KL, Chantarasorn V, Langer S, Phipps H, Dietz HP (2011) Does Epi-No Birth Trainer reduce levator trauma? A randomised controlled trial. Int Urogynecol J 22:1521–1528

    Article  PubMed  Google Scholar 

  22. Mørkved S, Bø K, Schei B, Salvesen KA (2003) Pelvic floor muscle training during pregnancy to prevent urinary incontinence: a single-blind randomized controlled trial. Obstet Gynecol 101:313–319

    Article  PubMed  Google Scholar 

Download references

Acknowledgment

We thank midwife Tone Breines Simonsen and physical therapist Kristin Gjestland for excellent work with recruiting participants, clinical testing and data entry and Professor of biostatistics Ingar Holme, Department of Sports Medicine, Norwegian School of Sport Sciences for valuable advice on statistical analyses. Thanks to Professor Ingrid Nygaard, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, USA, for English revision of the manuscript. The study was funded by the South-Eastern Norway Regional Health Authority and The Research Council of Norway.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Sports Medicine, Norwegian School of Sport Sciences, PO Box 4014, Ullevål stadion, 0806, Oslo, Norway

    Kari Bø & Gunvor Hilde

  2. Department of Obstetrics and Gynaecology, Akershus University Hospital, Lørenskog, Norway

    Kari Bø, Gunvor Hilde, Jette Stær Jensen, Franziska Siafarikas & Marie Ellstrøm Engh

  3. Faculty of Medicine, University of Oslo, Oslo, Norway

    Jette Stær Jensen, Franziska Siafarikas & Marie Ellstrøm Engh

Authors
  1. Kari Bø
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gunvor Hilde
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jette Stær Jensen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Franziska Siafarikas
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Marie Ellstrøm Engh
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kari Bø.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bø, K., Hilde, G., Jensen, J.S. et al. Too tight to give birth? Assessment of pelvic floor muscle function in 277 nulliparous pregnant women. Int Urogynecol J 24, 2065–2070 (2013). https://doi.org/10.1007/s00192-013-2133-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-013-2133-8

Keywords

Search

Navigation