Cathrine Reimers1,2, Franziska Siafarikas3, Jette Stær-Jensen3, Milada Cvancarova Småstuen4, Kari Bø3,5, Marie Ellström Engh3,6. 1. Department of Obstetrics and Gynecology, Akershus University Hospital, PO Box 1000, 1478, Lørenskog, Norway. creimers@online.no. 2. Division of Gynecology and Obstetrics, Oslo University Hospital, Oslo, Norway. creimers@online.no. 3. Department of Obstetrics and Gynecology, Akershus University Hospital, PO Box 1000, 1478, Lørenskog, Norway. 4. Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway. 5. Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway. 6. Faculty Division Akershus University Hospital, University of Oslo, Oslo, Norway.
Abstract
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. METHODS: 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. RESULTS: 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. CONCLUSION: Prelabor differences in the pelvic floor rather than obstetrical events were risk factors for aPOP at 6 weeks postpartum.
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. METHODS: 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. RESULTS: 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. CONCLUSION: Prelabor differences in the pelvic floor rather than obstetrical events were risk factors for aPOP at 6 weeks postpartum.
Entities:
Keywords:
POP; Pelvic floor; Pelvic organ prolapse; Postpartum; Pregnancy
Authors: Linda S Burkett; Timothy P Canavan; Stephanie M Glass Clark; Lauren E Giugale; Amanda M Artsen; Pamela A Moalli Journal: Int Urogynecol J Date: 2022-08-17 Impact factor: 1.932