David Sheyn1, Kateena L Addae-Konaedu2, Alison M Bauer2, Konyinsola I Dawodu3, David N Hackney4, Sherif A El-Nashar5. 1. University Hospitals Cleveland Medical Center, Division of Female Pelvic Medicine and Reconstructive Surgery, USA; Case Western Reserve University School of Medicine, USA. Electronic address: david.sheyn@uhhospitals.org. 2. University Hospitals Cleveland Medical Center, Department of Obstetrics and Gynecology, USA. 3. Case Western Reserve University School of Medicine, USA. 4. Case Western Reserve University School of Medicine, USA; University Hospitals Cleveland Medical Center, Division of Maternal Fetal Medicine, USA. 5. University Hospitals Cleveland Medical Center, Division of Female Pelvic Medicine and Reconstructive Surgery, USA; Case Western Reserve University School of Medicine, USA.
Abstract
OBJECTIVE: A likely contributor to pelvic floor disorders is injury and degradation of connective tissue components such as collagen and elastin, leading to weakening of the pelvic floor. Prior studies have found similar connective tissue component changes in women with cervical insufficiency (CI). However, the connection between pelvic floor disorders and cervical insufficiency has not previously been evaluated. Our objective was to determine whether a history of cervical insufficiency is associated with an increased risk of pelvic organ prolapse and stress urinary incontinence after controlling for confounders. STUDY DESIGN: The study used de-identified clinical data from a large multi-institution electronic health records HIPAA-compliant data web application, Explorys Inc. (Cleveland, Ohio, USA). Women with a history of at least one prior delivery after at least 20 weeks' gestation between the years 1999 and 2016 were identified. Logistic regression models were used to identify risk factors and adjust for confounders. MAIN OUTCOME MEASURES: The primary outcome was subsequent development of either stress incontinence or pelvic organ prolapse. RESULTS: A total of 1,182,650 women were identified, of whom 30,890 (2.6%) had a history of cervical cerclage or insufficiency. A history of cervical insufficiency was associated with an increased risk of either pelvic organ prolapse or stress urinary incontinence (aOR=1.93, 95%CI: 1.84-2.02). A history of cervical insufficiency was more strongly associated with an increased risk of pelvic organ prolapse (aOR=2.06, 95%CI: 1.91-2.21) than with stress urinary incontinence (aOR=1.91, 95%CI: 1.80-2.02). CONCLUSION: A history of cervical insufficiency is associated with an increased risk of development of pelvic organ prolapse and stress urinary incontinence.
OBJECTIVE: A likely contributor to pelvic floor disorders is injury and degradation of connective tissue components such as collagen and elastin, leading to weakening of the pelvic floor. Prior studies have found similar connective tissue component changes in women with cervical insufficiency (CI). However, the connection between pelvic floor disorders and cervical insufficiency has not previously been evaluated. Our objective was to determine whether a history of cervical insufficiency is associated with an increased risk of pelvic organ prolapse and stress urinary incontinence after controlling for confounders. STUDY DESIGN: The study used de-identified clinical data from a large multi-institution electronic health records HIPAA-compliant data web application, Explorys Inc. (Cleveland, Ohio, USA). Women with a history of at least one prior delivery after at least 20 weeks' gestation between the years 1999 and 2016 were identified. Logistic regression models were used to identify risk factors and adjust for confounders. MAIN OUTCOME MEASURES: The primary outcome was subsequent development of either stress incontinence or pelvic organ prolapse. RESULTS: A total of 1,182,650 women were identified, of whom 30,890 (2.6%) had a history of cervical cerclage or insufficiency. A history of cervical insufficiency was associated with an increased risk of either pelvic organ prolapse or stress urinary incontinence (aOR=1.93, 95%CI: 1.84-2.02). A history of cervical insufficiency was more strongly associated with an increased risk of pelvic organ prolapse (aOR=2.06, 95%CI: 1.91-2.21) than with stress urinary incontinence (aOR=1.91, 95%CI: 1.80-2.02). CONCLUSION: A history of cervical insufficiency is associated with an increased risk of development of pelvic organ prolapse and stress urinary incontinence.