Title :

Moderate or intensive management of the active phase of second-stage labor and risk of urinary and anal incontinence: results of the PASST randomized controlled trial.

Author(s) :

Dupuis, Ninon [Auteur]
Centre Hospitalier Universitaire de Toulouse [CHU Toulouse]
Obstetrical, Perinatal and Pediatric Epidemiology | Épidémiologie Obstétricale, Périnatale et Pédiatrique [EPOPé [CRESS - U1153 / UMR_A 1125]]
Pizzoferrato, Anne-Cécile [Auteur]
CHU Caen
Garabedian, Charles [Auteur]
Centre Hospitalier Régional Universitaire [CHU Lille] [CHRU Lille]
METRICS : Evaluation des technologies de santé et des pratiques médicales - ULR 2694
Kayem, Gilles [Auteur]
Obstetrical, Perinatal and Pediatric Epidemiology | Épidémiologie Obstétricale, Périnatale et Pédiatrique [EPOPé [CRESS - U1153 / UMR_A 1125]]
Harvey, Thierry [Auteur]
Groupe Hospitalier Diaconesses Croix Saint-Simon
Mandelbrot, Laurent [Auteur]
Assistance publique - Hôpitaux de Paris (AP-HP) [AP-HP]
Doret, Muriel [Auteur]
Hospices Civils de Lyon [HCL]
Fuchs, Florent [Auteur]
Centre Hospitalier Régional Universitaire [Montpellier] [CHRU Montpellier]
Azria, Elie [Auteur]
Obstetrical, Perinatal and Pediatric Epidemiology | Épidémiologie Obstétricale, Périnatale et Pédiatrique [EPOPé [CRESS - U1153 / UMR_A 1125]]
Sénat, Marie-Victoire [Auteur]
Hôpital Bicêtre [AP-HP, Le Kremlin-Bicêtre]
Ceccaldi, Pierre-François [Auteur]
Hôpital Beaujon [AP-HP]
Seco, Aurélien [Auteur]
Centre for Research in Epidemiology and Statistics | Centre de Recherche Épidémiologie et Statistiques [CRESS (U1153 / UMR_A 1125)]
Chantry, Anne [Auteur]
Obstetrical, Perinatal and Pediatric Epidemiology | Épidémiologie Obstétricale, Périnatale et Pédiatrique [EPOPé [CRESS - U1153 / UMR_A 1125]]
Le Ray, Camille [Auteur]
Obstetrical, Perinatal and Pediatric Epidemiology | Épidémiologie Obstétricale, Périnatale et Pédiatrique [EPOPé [CRESS - U1153 / UMR_A 1125]]

Journal title :

American Journal of Obstetrics and Gynecology

Abbreviated title :

Am J Obstet Gynecol

Publication date :

2023-07-29

ISSN :

1097-6868

English abstract : [en]

Background: Incontinence occurs frequently in the postpartum period. Several theoretical pathophysiological models may underlie the hypothesis that different types of management of the active phase of the second stage of ...
Show more >Background: Incontinence occurs frequently in the postpartum period. Several theoretical pathophysiological models may underlie the hypothesis that different types of management of the active phase of the second stage of labor have different effects on pelvic floor muscles and thus perhaps affect urinary and anal continence. Objective: This study aimed to evaluate the impact of “moderate pushing” on the occurrence of urinary or anal incontinence compared with “intensive pushing,” and to determine the factors associated with incontinence at 6 months postpartum. Study Design: This was a planned analysis of secondary objectives of the PASST (Phase Active du Second STade) trial, a multicenter randomized controlled trial. PASST included nulliparous women with singleton term pregnancies and epidural analgesia, who were randomly assigned at 8 cm of dilatation to either the intervention group that used “moderate” pushing (pushing only twice during each contraction, resting regularly for 1 contraction in 5 without pushing, and no time limit on pushing) or the control group following the usual management of “intensive” pushing (pushing 3 times during each contraction, with no contractions without pushing, with an obstetrician called to discuss operative delivery after 30 minutes of pushing). Data about continence were collected with validated self-assessment questionnaires at 6 months postpartum. Urinary incontinence was defined by an ICIQ-UI SF (International Consultation on Incontinence Questionnaire–Urinary Incontinence Short Form) score ≥1 and anal incontinence by a Wexner score ≥2. A separate analysis was also performed among the more severely affected women (ICIQ-UI SF ≥6 and Wexner ≥5). Factors associated with incontinence were assessed with univariate and multivariable analyses. Results: Among 1618 women initially randomized, 890 (55%) returned the complete questionnaire at 6 months. The rate of urinary incontinence was 36.6% in the “moderate” pushing group vs 38.5% in the “intensive” pushing group (relative risk, 0.95; 95% confidence interval, 0.80–1.13), whereas the rate of anal incontinence was 32.2% vs 34.6% (relative risk, 0.93; 95% confidence interval, 0.77–1.12). None of the obstetrical factors studied related to the second stage of labor influenced the occurrence of urinary or anal incontinence, except operative vaginal delivery, which increased the risk of anal incontinence (adjusted odds ratio, 1.50; 95% confidence interval, 1.04–2.15). Conclusion: The results of the PASST trial indicate that neither moderate nor intensive pushing efforts affect the risk of urinary or anal incontinence at 6 months postpartum among women who gave birth under epidural analgesia.Show less >

Language :

Anglais

Audience :

Internationale

Popular science :

Non

Administrative institution(s) :

Université de Lille
CHU Lille

Collections :

• METRICS : Evaluation des technologies de santé et des pratiques médicales - ULR 2694

Submission date :

2024-01-23T22:08:44Z
2024-04-10T12:09:31Z