{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T08:23:29Z","timestamp":1783499009922,"version":"3.55.0"},"reference-count":41,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2024,2,20]],"date-time":"2024-02-20T00:00:00Z","timestamp":1708387200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To investigate the effect of vacuum extraction (VE) or caesarean section (CS), compared with expectant management, on pelvic floor dysfunction (PFD) 1\u20132\u2009years postpartum in primiparous women with a prolonged second stage of labour.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>A population\u2010based questionnaire and cohort study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Stockholm, Sweden.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>A cohort of 1302 primiparous women with a second stage duration of \u22653\u2009h, delivering from December 2017 to November 2018.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The 1\u2010year follow\u2010up questionnaire from the Swedish National Perineal Laceration Register was distributed 12\u201324\u2009months postpartum. Exposure was VE or CS at 3\u20134\u2009h or 4\u20135\u2009h, compared with expectant management.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Pelvic floor dysfunction was defined as at least weekly symptoms of urinary incontinence, pelvic organ prolapse or a Wexner score of \u22654. The risk of PFD was calculated using Poisson regression with robust variance estimation, presented as crude and adjusted relative risks (RRs and aRRs) with 95% confidence intervals (95%\u2009CIs). The implication of obstetric anal sphincter injury (OASI) on pelvic floor disorders was investigated through mediation analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In total, 35.1% of women reported PFD. Compared with expectant management, the risk of PFD was increased after VE at 3\u20134\u2009h (aRR\u20091.33, 95%\u2009CI 1.06\u20131.65) and 4\u20135\u2009h (aRR\u20091.34, 95%\u2009CI 1.05\u20131.70), but remained unchanged after CS. The increased risk after VE was not mediated by OASI.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Pelvic floor dysfunction was common in primiparous women after a prolonged second stage, and the risk of PFD increased after VE but was unaffected by CS, compared with expectant management. If a spontaneous vaginal delivery eventually occurred, allowing an extended duration of labour did not increase the risk of PFD.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.17792","type":"journal-article","created":{"date-parts":[[2024,2,20]],"date-time":"2024-02-20T08:32:19Z","timestamp":1708417939000},"page":"1279-1289","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Pelvic floor dysfunction after intervention, compared with expectant management, in prolonged second stage of labour: A population\u2010based questionnaire and cohort study"],"prefix":"10.1111","volume":"131","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5147-7528","authenticated-orcid":false,"given":"Sandra","family":"Bergendahl","sequence":"first","affiliation":[{"name":"Department of Clinical Sciences Karolinska Institutet, Danderyd Hospital  Stockholm Sweden"},{"name":"BB Sankt G\u00f6ran, Capio Sankt G\u00f6ran Hospital  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2879-4271","authenticated-orcid":false,"given":"Anna","family":"Sandstr\u00f6m","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology Division, Department of Medicine Karolinska Institutet  Stockholm Sweden"},{"name":"Department of Women's Health Karolinska University Hospital  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8604-8694","authenticated-orcid":false,"given":"Hongwei","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, School of Public Health Texas University  College Station Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9566-3047","authenticated-orcid":false,"given":"Jonathan M.","family":"Snowden","sequence":"additional","affiliation":[{"name":"School of Public Health Oregon Health and Science University \u2013 Portland State University  Portland Oregon USA"},{"name":"Department of Obstetrics and Gynecology Oregon Health and Science University  Portland Oregon USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9401-8062","authenticated-orcid":false,"given":"Sophia","family":"Brismar\u00a0Wendel","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences Karolinska Institutet, Danderyd Hospital  Stockholm Sweden"},{"name":"Department of Women's Health, Danderyd Hospital  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,2,20]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2004.05.044"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.obstetgynecol.2003.10.011"},{"key":"e_1_2_12_4_1","volume-title":"WHO recommendations: intrapartum care for a positive childbirth experience","author":"WHO","year":"2018"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000000278"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1080\/14767058.2016.1174999"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2020.06.018"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2011.02928.x"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/nau.24442"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2012.03437.x"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-019-03975-0"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1080\/14767058.2021.1887122"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-022-11346-x"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.3109\/00016340903576004"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.12676"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2018.09.025"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2019.08.003"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajogmf.2022.100795"},{"key":"e_1_2_12_19_1","unstructured":"NICE.Intrapartum care for healthy women and babies (CG190). 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