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