Prolonged Second Stage of Labor and Postpartum Pelvic Floor Dysfunction.

Abstract

Importance: Parity and mode of delivery are common risk factors for pelvic floor dysfunction. The prolonged second stage of labor, defined as the time between complete cervical dilation and the expulsion of the fetal head, may be related to these changes and no pooled evidence has been tabulated to seek this association.

Objective: The aim of the study was to carry on a systematic review on the association between pelvic floor dysfunction symptoms and prolonged second stage of labor (PSSL).

Study design: A systematic search was conducted in the databases PubMed, Cochrane Library, Embase, SCOPUS, Web of Science, and LILACS on July and December 2024. Studies involving populations of women who experienced PSSL and in which the analyzed outcomes were symptoms of pelvic floor dysfunction were included. The ROBINS-I scale was used to assess methodological quality for observational studies.

Results: A total of 92 articles were fully analyzed, and 6 articles were selected. A meta-analysis could not be performed because of the heterogeneity of the primary outcome and the definition for PSSL. Two of 6 studies considered PSSL over 3 hours. Among the 6 studies, 3 showed no association between PSSL and pelvic floor dysfunction, 2 indicated an association with urinary incontinence, and one suggested a partial association. All studies presented a moderate overall risk of bias.

Conclusions: Half of the studies did not demonstrate an association between PSSL and pelvic floor dysfunction and the other half suggested an association. Further studies with PSSL as primary outcomes with cohort design are needed to clarify this question.