International Urogynecology Journal

, Volume 25, Issue 11, pp 1463–1470

Prevalence, etiology and risk factors of pelvic organ prolapse in premenopausal primiparous women

Authors

    • The Irish Centre for Fetal and Neonatal Translational Research (INFANT) and Department of Obstetrics and GynaecologyUniversity College Cork
    • Department of UrogynaecologyCork University Maternity Hospital (CUMH)
    • INFANT Research Centre, Department of Obstetrics and GynaecologyCork University Maternity Hospital
  • A. S. Khashan
    • The Irish Centre for Fetal and Neonatal Translational Research (INFANT) and Department of Obstetrics and GynaecologyUniversity College Cork
  • L. C. Kenny
    • The Irish Centre for Fetal and Neonatal Translational Research (INFANT) and Department of Obstetrics and GynaecologyUniversity College Cork
  • U. A. Durnea
    • The Irish Centre for Fetal and Neonatal Translational Research (INFANT) and Department of Obstetrics and GynaecologyUniversity College Cork
  • M. M. Smyth
    • School of MedicineUniversity College Cork
  • B. A. O’Reilly
    • The Irish Centre for Fetal and Neonatal Translational Research (INFANT) and Department of Obstetrics and GynaecologyUniversity College Cork
    • Department of UrogynaecologyCork University Maternity Hospital (CUMH)
Original Article

DOI: 10.1007/s00192-014-2382-1

Cite this article as:
Durnea, C.M., Khashan, A.S., Kenny, L.C. et al. Int Urogynecol J (2014) 25: 1463. doi:10.1007/s00192-014-2382-1

Abstract

Introduction

The natural history of pelvic organ prolapse (POP) is poorly understood. We investigated the prevalence and risk factors of postnatal POP in premenopausal primiparous women and the associated effect of mode of delivery.

Methods

We conducted a prospective cohort study in a tertiary teaching hospital attending 9,000 deliveries annually. Collagen-diseases history and clinical assessment was performed in 202 primiparae at ≥1 year postnatally. Assessment included Pelvic Organ Prolapse Quantification (POP-Q) system, Beighton mobility score, 2/3D-transperineal ultrasound (US) and quantification of collagen type III levels. Association with POP was assessed using various statistical tests, including logistic regression, where results with p < 0.1 in univariate analysis were included in multivariate analysis.

Results

POP had a high prevalence: uterine prolapse 89 %, cystocele 90 %, rectocele 70 % and up to 65 % having grade two on POP-Q staging. The majority had multicompartment involvement, and 80 % were asymptomatic. POP was significantly associated with joint hypermobility, vertebral hernia, varicose veins, asthma and high collagen type III levels (p < 0.05). In multivariate logistic regression, only levator ani muscle (LAM) avulsion was significant in selected cases (p < 0.05). Caesarean section (CS) was significantly protective against cystocele and rectocele but not for uterine prolapse.

Conclusions

Mild to moderate POP has a very high prevalence in premenopausal primiparous women. There is a significant association between POP, collagen levels, history of collagen disease and childbirth-related pelvic floor trauma. These findings support a congenital contribution to POP etiology, especially for uterine prolapse; however, pelvic trauma seems to play paramount role. CS is significantly protective against some types of prolapse only.

Keywords

Pelvic organ prolapsePrimiparousCystoceleRectoceleCollagen

Supplementary material

192_2014_2382_MOESM1_ESM.bmp (1.6 mb)
Online Appendix A1STARD flowchart indicating recruited numbers (BMP 1594 kb)
192_2014_2382_MOESM2_ESM.docx (13 kb)
Online Appendix A2Medical conditions potentially associated with collagen disorders (DOCX 12 kb)
192_2014_2382_MOESM3_ESM.xlsx (101 kb)
Online Appendix 3A POP-Q assessment and ultrasound estimate of POP-Q coordinates (XLSX 100 kb)

Copyright information

© The International Urogynecological Association 2014