Risk factors for anatomic pelvic organ prolapse at 6 weeks postpartum: a prospective observational study
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Introduction and hypothesis
The objective was to identify risk factors for postpartum anatomic pelvic organ prolapse (aPOP) by comparing women with and without aPOP at 6 weeks postpartum with regard to pelvic floor measurements antepartum and obstetrical characteristics.
We carried out a prospective observational cohort study including nulliparous pregnant women in a Norwegian university hospital. Participants underwent clinical examinations, including pelvic organ prolapse quantification system (POP-Q) and transperineal ultrasound at gestational week 21 and at 6 weeks postpartum. Background and obstetrical information was obtained from an electronic questionnaire and from the patient’s electronic medical file respectively. Associations were estimated using logistic regression analyses. The dependent variable was aPOP, defined as POP-Q stage ≥2 at 6 weeks postpartum. Independent variables were mid-pregnancy measurements of selected POP-Q variables and levator hiatus area (LHarea), delivery route, and the presence of major levator ani muscle (LAM) injuries at 6 weeks postpartum.
A larger LHarea, a more distensible LAM, a longer distance from the meatus urethra to the anus (Gh + Pb) and a more caudal position of the anterior vaginal wall (Ba) at mid-pregnancy were risk factors for aPOP at 6 weeks postpartum, whereas delivery route and the presence of major LAM injuries were not.
Prelabor differences in the pelvic floor rather than obstetrical events were risk factors for aPOP at 6 weeks postpartum.
KeywordsPelvic organ prolapse Pelvic floor POP Postpartum Pregnancy
The authors would like to thank the women who participated in the study and midwife Tone Breines Simonsen, who administered the assembling and follow-up of the cohort. We would also like to thank the physiotherapists Gunvor Hilde and Kristin Gjestland for data analysis of the ultrasound volumes.
The study has been funded by the South-Eastern Norway Regional Health Authority and by the Research Council of Norway.
Compliance with ethical standards
The Regional Ethics Committee (REK Southeast D 2009/170) and the Akershus University Hospital Privacy Ombudsman (2799026) approved the study. All participants gave their written informed consent before entering the study.
All authors have revised the drafted article critically for important intellectual content and have approved the submitted article.
Conflicts of interest