The distribution of pelvic organ support in a population of female subjects seen for routine gynecologic health care.

OBJECTIVE This study was undertaken to describe the distribution of pelvic organ support stages in a population of women seen at outpatient gynecology clinics for routine gynecologic health care. STUDY DESIGN This was an observational study. Women seen for routine gynecologic health care at four outpatient gynecology clinics were recruited to participate. After informed consent was obtained general biographic data were collected regarding obstetric history, medical history, and surgical history. Women then underwent a pelvic examination. Pelvic organ support was measured and described according to the pelvic organ prolapse quantification system. Stages of support were evaluated by variable for trends with Pearson chi(2) statistics. RESULTS A total of 497 women were examined. The average age was 44 years, with a range of 18 to 82 years. The overall distribution of pelvic organ prolapse quantification system stages was as follows: stage 0, 6.4%; stage 1, 43.3%; stage 2, 47.7%; and stage 3, 2.6%. No subjects examined had pelvic organ prolapse quantification system stage 4 prolapse. Variables with a statistically significant trend toward increased pelvic organ prolapse quantification system stage were advancing age, increasing gravidity and parity, increasing number of vaginal births, delivery of a macrosomic infant, history of hysterectomy or pelvic organ prolapse operations, postmenopausal status, and hypertension. CONCLUSION The distribution of the pelvic organ prolapse quantification system stages in the population revealed a bell-shaped curve, with most subjects having stage 1 or 2 support. Few subjects had either stage 0 (excellent support) or stage 3 (moderate to severe pelvic support defects) results. There was a statistically significant trend toward increased pelvic organ prolapse quantification system stage of support among women with many of the historically quoted etiologic factors for the development of pelvic organ prolapse.

[1]  K. Matthews,et al.  Prevalence, incidence and correlates of urinary incontinence in healthy, middle-aged women. , 1991, The Journal of urology.

[2]  C. Beecham.  Classification of vaginal relaxation. , 1980, American journal of obstetrics and gynecology.

[3]  J. Colling,et al.  Epidemiology of Surgically Managed Pelvic Organ Prolapse and Urinary Incontinence , 1997, Obstetrics and gynecology.

[4]  S. Swift,et al.  Comparison of Pelvic Organ Prolapse in the Dorsal Lithotomy Compared With the Standing Position , 1998, Obstetrics and gynecology.

[5]  Porges Rf.  A PRACTICAL SYSTEM OF DIAGNOSIS AND CLASSIFICATION OF PELVIC RELAXATIONS. , 1963 .

[6]  K. Richter.  Massive Eversion of the Vagina: Pathogenesis, Diagnosis, and Therapy of the “True” Prolapse of the Vaginal Stump , 1982, Clinical obstetrics and gynecology.

[7]  L. Brubaker,et al.  The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. , 1996, American journal of obstetrics and gynecology.

[8]  H. Valkenburg,et al.  Urinary incontinence in women from 35 to 79 years of age: prevalence and consequences. , 1992, European journal of obstetrics, gynecology, and reproductive biology.

[9]  M. Vessey,et al.  Epidemiology of genital prolapse: observations from the Oxford Family Planning Association study , 1997, British journal of obstetrics and gynaecology.

[10]  R. E. Allen,et al.  Pelvic floor damage and childbirth: a neurophysiological study , 1990 .

[11]  J. Brocklehurst.  Urinary incontinence in the community--analysis of a MORI poll. , 1993, BMJ.

[12]  M. J. Webb,et al.  Posthysterectomy enterocele and vaginal vault prolapse. , 1981, American journal of obstetrics and gynecology.

[13]  J. Mäkinen,et al.  Retrospective analysis of 711 patients operated on for pelvic relaxation in 1983–1989 , 1993, International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics.

[14]  M. Vitolins,et al.  Use of the Pelvic Organ Prolapse staging system of the International Continence Society, American Urogynecologic Society, and Society of Gynecologic Surgeons in perimenopausal women. , 1999, American journal of obstetrics and gynecology.

[15]  K. Svärdsudd,et al.  Signs of genital prolapse in a Swedish population of women 20 to 59 years of age and possible related factors. , 1999, American journal of obstetrics and gynecology.

[16]  Robert L. Harris,et al.  Interobserver and intraobserver reliability of the proposed International Continence Society, Society of Gynecologic Surgeons, and American Urogynecologic Society pelvic organ prolapse classification system. , 1996, American journal of obstetrics and gynecology.

[17]  L. Wall,et al.  Clinical features of urinary incontinence and urogenital prolapse in a black inner-city population. , 1994, American journal of obstetrics and gynecology.

[18]  G. Hosker,et al.  The role of partial denervation of the pelvic floor in the aetiology of genitourinary prolapse and stress incontinence of urine. A neurophysiological study , 1989, British journal of obstetrics and gynaecology.

[19]  J. Dyerberg,et al.  TRANEXAMIC ACID: A NEW APPROACH TO AUTOIMMUNE DISEASE ? , 1975, The Lancet.

[20]  Baden Wf,et al.  The vaginal profile. , 1968 .

[21]  M. Swash,et al.  INJURY TO INNERVATION OF PELVIC FLOOR SPHINCTER MUSCULATURE IN CHILDBIRTH , 1984, The Lancet.

[22]  A. Herzog,et al.  Prevalence and Incidence of Urinary Incontinence in Community‐Dwelling Populations , 1990, Journal of the American Geriatrics Society.

[23]  W. A. Little,et al.  The conflict in nomenclature for descensus uteri. , 1961, American journal of obstetrics and gynecology.

[24]  R. Bump,et al.  Racial comparisons and contrasts in urinary incontinence and pelvic organ prolapse , 1993, Obstetrics and gynecology.

[25]  H. Gürel,et al.  Pelvic relaxation and associated risk factors, The results of logistic regression analysis , 1999, Acta obstetricia et gynecologica Scandinavica.