{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T15:30:34Z","timestamp":1789659034419,"version":"4.0.1"},"reference-count":32,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2014,2,19]],"date-time":"2014-02-19T00:00:00Z","timestamp":1392768000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000071","name":"National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["1R01HD049819-01A2"],"award-info":[{"award-number":["1R01HD049819-01A2"]}],"id":[{"id":"10.13039\/100000071","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2014,8]]},"abstract":"Objective<\/jats:title>Maternal expulsive efforts are thought to damage the pelvic floor. We aimed to compare pelvic floor function and anatomy between women who delivered vaginally (VB<\/jats:styled-content>) versus those with caesarean delivery (CD<\/jats:styled-content>) prior to the second stage of labour.<\/jats:p><\/jats:sec>Design<\/jats:title>Prospective cohort.<\/jats:p><\/jats:sec>Setting<\/jats:title>U<\/jats:styled-content>niversity H<\/jats:styled-content>ospital M<\/jats:styled-content>idwifery practice.<\/jats:p><\/jats:sec>Population<\/jats:title>Nulliparas.<\/jats:p><\/jats:sec>Methods<\/jats:title>Pregnant nulliparas were recruited during pregnancy and women who underwent CD<\/jats:styled-content> prior to the 2nd stage of labour at birth were recruited immediately postpartum. Both groups were followed prospectively to 6\u00a0months postpartum.<\/jats:p><\/jats:sec>Main outcome measures<\/jats:title>POPQ<\/jats:styled-content>, perineal ultrasound (U<\/jats:styled-content>\/S<\/jats:styled-content>) and P<\/jats:styled-content>aper T<\/jats:styled-content>owel T<\/jats:styled-content>est (PTT<\/jats:styled-content>), an objective measure of stress incontinence; Incontinence Severity Index (ISI<\/jats:styled-content>), Pelvic Floor Impact Questionnaire (PFIQ<\/jats:styled-content>\u20107), Wexner Fecal Incontinence Scale (W) and Female Sexual Function Index (FSFI<\/jats:styled-content>).<\/jats:p><\/jats:sec>Results<\/jats:title>336\/448 (75%) VB<\/jats:styled-content> and 138\/224 (62%) CD<\/jats:styled-content> followed up. The VB<\/jats:styled-content> group was younger (23.9\u00a0\u00b1\u00a04.9 versus 26.6\u00a0\u00b1\u00a06.1\u00a0years, P<\/jats:italic>\u00a0<\u00a00.001) and less overweight\/obese (38 versus 56%, P\u00a0<\/jats:italic><\u00a00.001); baseline functional measures were similar (all P<\/jats:italic>\u00a0>\u00a00.05). At follow\u2010up, urinary incontinence (UI<\/jats:styled-content>) (55 versus 46% ISI<\/jats:styled-content>\u00a0>\u00a00, P<\/jats:italic>\u00a0=\u00a00.10), fecal incontinence (FI<\/jats:styled-content>) (8 versus 13% FI<\/jats:styled-content> on W, P<\/jats:italic>\u00a0=\u00a00.12), sexual activity rates (88 versus 92%, P<\/jats:italic>\u00a0=\u00a00.18) and PFIQ<\/jats:styled-content>\u2010seven scores were similar. Positive PTT<\/jats:styled-content> tests (17 versus 6%, P<\/jats:italic>\u00a0=\u00a00.002) and \u2265 Stage 2 prolapse (22 versus 15%, P<\/jats:italic>\u00a0=\u00a00.03) were higher with VB<\/jats:styled-content>; differences were limited to points A<\/jats:styled-content>a and B<\/jats:styled-content>a. U<\/jats:styled-content>\/S<\/jats:styled-content> findings were not different between groups. Stepwise multivariate analyses controlling for age, body mass index, and non\u2010Hispanic White race for prolapse of points A<\/jats:styled-content>a and B<\/jats:styled-content>a did not alter conclusions (all P\u00a0<\/jats:italic><\u00a00.004).<\/jats:p><\/jats:sec>Conclusions<\/jats:title>VB<\/jats:styled-content> resulted in prolapse changes and objective UI<\/jats:styled-content> but not in increased self\u2010report pelvic floor dysfunction at 6\u00a0months postpartum compared with women who delivered by CD<\/jats:styled-content> prior to the second stage of labour. The second stage of labour had a modest effect on postpartum pelvic floor function.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.12571","type":"journal-article","created":{"date-parts":[[2014,2,19]],"date-time":"2014-02-19T07:26:49Z","timestamp":1392794809000},"page":"1145-1154","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":86,"title":["Contribution of the second stage of labour to pelvic floor dysfunction: a prospective cohort comparison of nulliparous women"],"prefix":"10.1111","volume":"121","author":[{"given":"RG","family":"Rogers","sequence":"first","affiliation":[{"name":"Departments of Obstetrics and Gynecology and Surgery University of New Mexico Health Sciences Center Albuquerque NM USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"LM","family":"Leeman","sequence":"additional","affiliation":[{"name":"Departments of Family Medicine and Obstetrics and Gynecology University of New Mexico Health Sciences Center Albuquerque NM USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N","family":"Borders","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of New Mexico Health Sciences Center Albuquerque NM USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C","family":"Qualls","sequence":"additional","affiliation":[{"name":"Clinical and Translational Research Center Biostatistical core University of New Mexico Health Sciences Center Albuquerque NM USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"AM","family":"Fullilove","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of New Mexico Health Sciences Center Albuquerque NM USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D","family":"Teaf","sequence":"additional","affiliation":[{"name":"University of New Mexico Health Sciences Center Albuquerque NM USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"RJ","family":"Hall","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of New Mexico Health Sciences Center Albuquerque NM USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E","family":"Bedrick","sequence":"additional","affiliation":[{"name":"Division of Epidemiology University of New Mexico Health Sciences Center Albuquerque NM USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"LL","family":"Albers","sequence":"additional","affiliation":[{"name":"College of Nursing University of New Mexico Health Sciences Center Albuquerque NM USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2014,2,19]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa021788"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2010.08.034"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e318240df4f"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e3182267f2f"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ogc.2011.03.002"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2004.08.004"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.obstetgynecol.2003.09.013"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9378(96)70243-0"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006199-198905000-00002"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.322.7294.1096"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2004.07.037"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2004.12.025"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1067\/mob.2001.118659"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02050307"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/0304-3959(87)91074-8"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1080\/009262300278597"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1080\/713847100"},{"key":"e_1_2_10_19_1","first-page":"1585","article-title":"Repair of obstetric perineal lacerations","volume":"68","author":"Leeman L","year":"2003","journal-title":"Am Fam Physician"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0029-7844(98)00045-3"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2004.11.045"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-007-0402-0"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.293.17.2141"},{"key":"e_1_2_10_24_1","first-page":"Art. 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