ObjectiveTo investigate the effect of vacuum extraction (VE) or caesarean section (CS), compared with expectant management, on pelvic floor dysfunction (PFD) 1–2 years postpartum in primiparous women with a prolonged second stage of labour.DesignA population‐based questionnaire and cohort study.SettingStockholm, Sweden.PopulationA cohort of 1302 primiparous women with a second stage duration of ≥3 h, delivering from December 2017 to November 2018.MethodsThe 1‐year follow‐up questionnaire from the Swedish National Perineal Laceration Register was distributed 12–24 months postpartum. Exposure was VE or CS at 3–4 h or 4–5 h, compared with expectant management.Main outcome measuresPelvic floor dysfunction was defined as at least weekly symptoms of urinary incontinence, pelvic organ prolapse or a Wexner score of ≥4. 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% CIs). The implication of obstetric anal sphincter injury (OASI) on pelvic floor disorders was investigated through mediation analysis.ResultsIn total, 35.1% of women reported PFD. Compared with expectant management, the risk of PFD was increased after VE at 3–4 h (aRR 1.33, 95% CI 1.06–1.65) and 4–5 h (aRR 1.34, 95% CI 1.05–1.70), but remained unchanged after CS. The increased risk after VE was not mediated by OASI.ConclusionsPelvic 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.

中文翻译：

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与期待治疗相比，第二产程延长时干预后盆底功能障碍：基于人群的问卷调查和队列研究

目的 探讨与期待治疗相比，负压吸引术（VE）或剖腹产术（CS）对第二产程延长的初产妇产后 1-2 年盆底功能障碍（PFD）的影响。设计基于人群的调查问卷和队列研究。地点瑞典斯德哥尔摩。人群由 1302 名第二产程持续时间≥3 小时的初产妇组成的队列，分娩时间为 2017 年 12 月至 2018 年 11 月。方法瑞典国家会阴撕裂登记处发放了 1 年随访调查问卷12 –产后 24 个月。与期待治疗相比，暴露在 3-4 小时或 4-5 小时时为 VE 或 CS。主要结局指标盆底功能障碍定义为至少每周出现尿失禁、盆腔器官脱垂或 Wexner 评分≥4 的症状。PFD 的风险是使用泊松回归和稳健方差估计来计算的，以粗略和调整后的相对风险（RR 和 aRR）的形式表示，置信区间为 95%（95% CI）。通过中介分析调查产科肛门括约肌损伤 (OASI) 对盆底疾病的影响。结果总共有 35.1% 的女性报告有 PFD。与期待治疗相比，VE 后 3-4 小时（aRR 1.33，95% CI 1.06-1.65）和 4-5 小时（aRR 1.34，95% CI 1.05-1.70）PFD 风险增加，但术后保持不变。 CS。VE后风险增加并非由OASI介导。结论与期待治疗相比，盆底功能障碍在第二产程延长后的初产妇中很常见，VE后PFD风险增加，但不受CS影响。如果最终发生自然阴道分娩，延长产程不会增加 PFD 的风险。