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The role of prepregnancy pelvic floor dysfunction in postnatal pelvic morbidity in primiparous women


Introduction and hypothesis

Little is known about the natural history of pelvic floor dysfunction (PFD). We investigated the association between prepregnancy and postnatal PFD in premenopausal primiparous women and the associated effect of mode of delivery.


A prospective cohort study, nested within the parent Screening for Pregnancy Endpoints (SCOPE) study, was performed in a tertiary referral teaching hospital with approximately 9,000 deliveries per annum. The validated Australian pelvic floor questionnaire was completed by 872 nulliparous women at 15 weeks’ gestation, at the time of recruitment to the SCOPE study and 1 year postnatally. The questionnaire contained four sections with questions about urinary, faecal, prolapse and sexual dysfunction.


One year postnatally urinary dysfunction was present in 73 %, faecal in 49 %, prolapse in 14 % and sexual in 58 % of participants. Prepregnancy PFD persistent postnatally constituted more than half of total PFD. The majority of affected (71 %) had multicompartment involvement. Participants with persistent PFD had higher prevalence of severe symptoms and bothersome symptoms within the group. Severity of prepregnancy PFD worsened in <15 % cases postnatally.


The main damage to the pelvic floor seems to occur in the majority of patients before first pregnancy, where first childbearing does not worsen prepregnancy PFD in the majority of cases. Pregnancy appears to affect more pre-existing symptoms of urgency and urge incontinence comparing to stress incontinence. Caesarean section seems to be more protective against postnatal worsening of prepregnancy PFD comparing to de novo onset pathology. However, larger studies are needed to confirm these findings.

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We would like to thank all SCOPE Ireland participants, Continence Foundation Ireland and The Irish Centre for Fetal and Neonatal Translational Research (INFANT) for their input into this research project.


SCOPE Ireland is funded by Health Research Board of Ireland (grant reference CSA 2007/2). The study was supported by Continence Foundation Ireland and INFANT Research Centre, UCC. This work was funded in part by Science Foundation Ireland.

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Correspondence to C. M. Durnea.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Online Appendix A1

STARD flow chart indicating recruited number (BMP 352 kb)

Online Appendix A2

Australian pelvic floor questionnaire (PDF 797 kb)

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Durnea, C.M., Khashan, A.S., Kenny, L.C. et al. The role of prepregnancy pelvic floor dysfunction in postnatal pelvic morbidity in primiparous women. Int Urogynecol J 25, 1363–1374 (2014).

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  • 4P study
  • Incontinence
  • Primiparous
  • PFD
  • Prolapse
  • Urge