Longitudinal Changes in Pelvic Organ Support Among Parous Women

Objective The objective of this study was to characterize changes in pelvic organ support and symptoms of prolapse over time and identify characteristics associated with worsening of support. Methods Participants were recruited based on the mode of delivery (cesarean vs vaginal delivery) of their first child. The Pelvic Organ Prolapse Quantification system was used to describe support at baseline and 12 to 18 months later. Symptoms were assessed using a validated questionnaire. Outcomes of interest included the proportion of women with a change in support greater than 1 cm at the anterior vaginal wall (Ba) or posterior vaginal wall (Bp) and a change in support greater than 2 cm at the apex (C). Characteristics associated with worsening of support were identified using 2-sided Fisher’s exact test and multivariable logistic regression. Results Among 749 participants, 60% had delivered by cesarean delivery only. Worsening support at Ba, Bp, and C was observed in 8%, 2%, and 6%, respectively. Worsening at any point was observed in 110 women (15%). Women with prolapse symptoms at baseline were not more likely to experience worsening of support. In a multivariable model, age older than 40 years (odds ratio [OR], 1.64; 95% confidence interval [CI], 1.09–2.49), vaginal delivery (OR, 3.12; 95% CI, 1.38–7.07), and genital hiatus greater than or equal to 2 (OR, 2.36; 95% CI, 1.03–5.43) were all associated with worsening support in at least 1 compartment. Conclusions Over 12 to 18 months, characteristics most strongly associated with worsening of pelvic support include genital hiatus size, vaginal birth, and age.

[1]  H. Dietz,et al.  Can ballooning of the levator hiatus be determined clinically? , 2012, American journal of obstetrics and gynecology.

[2]  A. Muñoz,et al.  Pelvic Floor Disorders 5–10 Years After Vaginal or Cesarean Childbirth , 2011, Obstetrics and gynecology.

[3]  H. Dietz,et al.  Intrapartum risk factors for levator trauma , 2010, BJOG : an international journal of obstetrics and gynaecology.

[4]  Morton B. Brown,et al.  Correlation between levator ani muscle injuries on magnetic resonance imaging and fecal incontinence, pelvic organ prolapse, and urinary incontinence in primiparous women. , 2010, American journal of obstetrics and gynecology.

[5]  W. Ye,et al.  Pelvic organ support among primiparous women in the first year after childbirth , 2009, International Urogynecology Journal.

[6]  D. Fenner,et al.  Self-perceived natural history of pelvic organ prolapse described by women presenting for treatment , 2009, International Urogynecology Journal.

[7]  D. Ford,et al.  Is there a pelvic organ prolapse threshold that predicts pelvic floor symptoms? , 2008, American journal of obstetrics and gynecology.

[8]  C. Bradley,et al.  Vaginal Descent and Pelvic Floor Symptoms in Postmenopausal Women: A Longitudinal Study , 2008, Obstetrics and gynecology.

[9]  K. Candiotti,et al.  Wide genital hiatus is a risk factor for recurrence following anterior vaginal repair , 2008, International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics.

[10]  C. Bradley,et al.  Natural History of Pelvic Organ Prolapse in Postmenopausal Women , 2007, Obstetrics and gynecology.

[11]  J. Ashton-Miller,et al.  Interaction Among Apical Support, Levator Ani Impairment, and Anterior Vaginal Wall Prolapse , 2006, Obstetrics and gynecology.

[12]  E. Lukacz,et al.  Epidemiology of prolapse and incontinence questionnaire: validation of a new epidemiologic survey , 2005, International Urogynecology Journal.

[13]  B. Calhoun,et al.  Pelvic organ support in pregnancy and postpartum , 2004, International Urogynecology Journal.

[14]  E. Garrett,et al.  Progression and remission of pelvic organ prolapse: a longitudinal study of menopausal women. , 2004, American journal of obstetrics and gynecology.

[15]  Xiuhong Li,et al.  A Diamond-Shaped Equiponderant Graphical Display of the Effects of Two Categorical Predictors on Continuous Outcomes , 2003 .

[16]  E. Sze,et al.  Pregnancy, Labor, Delivery, and Pelvic Organ Prolapse , 2002, Obstetrics and gynecology.

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