Study: Fetal head station during OVD does not increase sexual dysfunction/postpartum depression

Midpelvic attempted operative vaginal delivery (aOVD) does not increase risk of sexual dysfunction in women or their male partners nor are the women more likely to manifest symptoms of maternal postpartum depression at 6 months compared to counterparts who had low pelvic aOVD, according to a prospective study in PLOS One.

The study, which was conducted at a tertiary care university hospital in France, from 2008 to 2013, included 1,941 women with a singleton term fetus in vertex presentation. Fewer than 50% (n = 907) of the women completed a sexual function and depression survey at 6 months, 18.4% of whom had midpelvic aOVD and 81.6% of whom had low pelvic aOVD. The entire cohort comprised heterosexual couples, of whom 96.3% reported sexual activity at 6 months.

The mean Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Short Form Questionnaire (PISQ-12) for this large subgroup was 38.6, the same for both midpelvic and low pelvic aOVD. Similarly, the mean score for symptoms of male sexual dysfunction using the International Index of Erectile Function (IIEF) was comparable for either fetal head position.

“Despite the lack of increased risk of sexual dysfunction or postpartum depression in women who had midpelvic aOVD, high rates of symptoms of maternal postpartum depression in general (23.3%) and dyspareunia (24.7%) 6 months after OVD for both fetal head stations were reported,” says lead author Guillaume Ducarme, MD, head of the Department of Obstetrics and Gynecology at Hospital La Roche sur Yon in France.

The current study also concluded that perineal pain significantly increased the risk of male and female sexual dysfunction and maternal symptoms of postpartum depression 6 months after OVD.

A previous study headed by Dr. Ducarme that was published in the journal Obstetrics & Gynecology in 2015 found that in a large prospective population-based cohort study of women (n=2,138) who underwent an OVD from December 2008 to October 2013 at Angers University Hospital in France, “midpelvic delivery was not associated with a higher rate of severe short-term maternal and neonatal morbidity than attempted low pelvic delivery, thus supporting the continued use of midpelvic delivery in appropriately selected candidates,” Dr. Ducarme told Contemporary OB/GYN.

 “Nonetheless, midpelvic aOVD may subsequently have a hidden mid- and long-term effect that may justify a cesarean delivery at full dilatation rather than an aOVD when the fetus is at midpelvic,” Dr. Ducarme says. “Therefore, it is crucial to assess mid- and long-term maternal outcome after midpelvic aOVD.”

A separate analysis of the university hospital cohort, again led by Dr. Ducarme and appearing in PLOS One in 2016, concluded that neither urinary nor anal incontinence differed at 6 months among women who had either midpelvic or low pelvic aOVD.

“The findings of the current study at 6 months should help clinicians inform women and their partners what to expect after a midpelvic aOVD,” Dr. Ducarme said. “And although the data at 6 months postpartum are reassuring, long-term studies of 2 to 5 years after aOVD are needed to confirm these short-term data.”