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Long-term effects of vacuum extraction on pelvic floor function: a cohort study in primipara

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Abstract

Introduction and hypothesis

We describe the prevalence of symptomatic pelvic organ prolapse (sPOP), urinary incontinence (UI), fecal incontinence (FI) and obstetric anal sphincter injury (OASI) 20 years after one vacuum extraction (VE) delivery compared with one spontaneous vaginal delivery (SVD) or one acute caesarean section (ACS).

Method

We performed a register-based national cohort study of primipara who delivered between 1985 and 1988 and had no further deliveries. Medical Birth Register data were linked to data from postal questionnaires distributed 20 years after the birth (response rate 65.2 %, n = 5 236). Main outcome measures were prevalence and risk factors for pelvic floor disorders (PFDs) and OASI and their impact after VE compared with SVD and ACS. Multivariate logistic regression models were used.

Results

The late prevalence of UI, sPOP, and FI was almost identical between VE and SVD. VE almost tripled the rate of OASI compared with SVD (6.3 vs. 2.4 %, p < 0.001). FI rate after an OASI was similar for both VE and SVD [30.2 vs. 27.8 %, adjusted odds ratio (aOR) 1.12; 95 % confidence interval (CI) 0.49–2.56]. Comparing VE without laceration with VE complicated by OASI increased the rate of FI (from 15.4 to 30.2 %, aOR 2.55; 95 % CI 1.26–5.15) and UI (from 39.0 to 61.4 %, aOR 2.28; 95 % CI 1.19–4.34), but the rate of sPOP was almost unaltered (from 15.0 to 15.9 %).

Conclusions

VE did not result in additional long-term PFDs provided the rate of OASI was similar to that after SVD. OASI after VE substantially increased the prevalence of FI and UI but did not alter the rate of sPOP.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden

    Ida Nilsson, Ian Milsom & Maria Gyhagen

  2. Department of Surgery, Södra Älvsborgs Hospital, Borås, Sweden

    Sigvard Åkervall

  3. Department of Obstetrics and Gynecology, Södra Älvsborgs Hospital, SE-501 82, Borås, Sweden

    Maria Gyhagen

Authors
  1. Ida Nilsson
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  2. Sigvard Åkervall
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  3. Ian Milsom
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  4. Maria Gyhagen
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Corresponding author

Correspondence to Maria Gyhagen.

Ethics declarations

Ethical approval

Ethical approval for the SWEPOP study was obtained from the regional (reference no. 381–07, August 13 2007) and national (34-9148/2007, October 26, 2007) Ethical Review Boards. All women gave written information before participation.

Funding

The study was supported by a National LUA/ALF grant nr 11315, a grant from the Region of Västra Götaland, Sweden, grants from The Göteborg Medical Society and Hjalmar Svenssons Fund, The funding source had no role in study design, data analysis, data interpretation, or writing of the report. MG and IM had full access to all study data and had final responsibility for the decision to submit for publication.

Conflicts of interest

None.

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Nilsson, I., Åkervall, S., Milsom, I. et al. Long-term effects of vacuum extraction on pelvic floor function: a cohort study in primipara. Int Urogynecol J 27, 1051–1056 (2016). https://doi.org/10.1007/s00192-015-2928-x

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  • DOI: https://doi.org/10.1007/s00192-015-2928-x

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