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Pregnancy, labour and delivery as risk factors for pelvic organ prolapse: a systematic review

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Abstract

Introduction

Pregnancy and childbirth are considered risk factors for pelvic organ prolapse (POP). The long latency between obstetric events and morbidity hinders the establishment of cause-effect relationships. Recently, intermediate outcomes such as organ descent and levator avulsion (LA) have been identified. We aimed to assess the effect of obstetric events on symptoms and signs of POP and on LA.

Methods

We systematically reviewed the literature by searching PubMed/MEDLINE, Embase and Cochrane Library. We included studies in women examining associations between obstetric events and symptoms and signs of POP and LA, assessed through questionnaires, clinical examination and pelvic floor imaging. Two reviewers evaluated the studies for eligibility and for methodological quality/susceptibility to bias. We extracted study results and clustered them by outcome: symptoms of POP (sPOP), clinical findings of POP (cPOP) and LA. When appropriate, we performed a random-effect meta-analysis and reported the summary odds ratios (OR) with 95% confidence intervals. Heterogeneity across studies was assessed using the I2 statistic.

Results

The first vaginal delivery was a risk factor for POP as measured by sPOP (OR: 2.65 [1.81–3.88]), cPOP (OR: 4.85 [2.15–10.94]) and in association with LA (OR: 41.6 [4.13– 419.41]). Forceps delivery was a risk factor for POP as measured by sPOP (OR: 2.51 [1.34–4.69]), cPOP (OR: 1.68 [1.21–2.34]) and in association with LA (OR: 5.92 [3.75–9.34]). Birth exclusively by caesarean was protective for sPOP (OR: 0.38 [0.29–0.51]) and for cPOP (OR: 0.29 [0.20–0.41]) and it did not confer any additional risk compared to nulliparity.

Conclusions

This review confirms a strong aetiological link between vaginal birth and POP, with the first vaginal and forceps delivery being the main determinants.

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Authors and Affiliations

  1. Department Development and Regeneration, Cluster Urogenital Surgery, Biomedical Sciences, KU Leuven, Leuven, Belgium

    Laura Cattani, Ann-Sophie Page & Jan Deprest

  2. Department of Gynaecology and Obstetrics, UZ Leuven, Herestraat 49, B-3000, Leuven, Belgium

    Laura Cattani, Judit Decoene & Jan Deprest

  3. Sydney Medical School Nepean, Nepean Hospital, Penrith, NSW, 2750, Australia

    Natalie Weeg & Hans Peter Dietz

  4. Research Department of Maternal Fetal Medicine, Institute for Women’s Health, University College London, London, UK

    Jan Deprest

Authors
  1. Laura Cattani
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  2. Judit Decoene
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  3. Ann-Sophie Page
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  4. Natalie Weeg
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  5. Jan Deprest
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  6. Hans Peter Dietz
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Corresponding author

Correspondence to Jan Deprest.

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Conflict of interest

HP Dietz has received honoraria and travel assistance from GE Medical and Mindray. J Deprest has received educational grants from GE Medical, which were handled by the KU Leuven Transfer office, which were not for conducting this review. The other authors have no conflicts of interest associated with this publication and there has been no financial support for this work.

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Report on behalf the subgroup “Labour and Delivery” of the International Urogynecological Consultation on the pathophysiology of pelvic organ prolapse

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Cattani, L., Decoene, J., Page, AS. et al. Pregnancy, labour and delivery as risk factors for pelvic organ prolapse: a systematic review. Int Urogynecol J 32, 1623–1631 (2021). https://doi.org/10.1007/s00192-021-04724-y

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  • DOI: https://doi.org/10.1007/s00192-021-04724-y

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