Change in pelvic organ support during pregnancy and the first year postpartum: a longitudinal study

Abstract

Summary Objective To describe changes in pelvic organ support from mid pregnancy until 1 year postpartum among nulliparous pregnant women, and to examine whether delivery route affects changes in pelvic organ support.Design Prospective cohort study. Setting Akershus University Hospital in Norway.Population A cohort of 300 nulliparous pregnant women included at mid-pregnancy.Methods Pelvic organ support assessed at 21 and 37 weeks of gestation, and again at 6 weeks, 6 months, and 12 months postpartum, by the use of the Pelvic Organ Prolapse Quantification (POP-Q) system. Linear mixed model was used to assess longitudinal change in pelvic organ support.Main outcome measures Prevalence of anatomic POP. Change in POP-Q variables over time and between delivery groups.Results The prevalence of anatomic POP ranged from 0 to 10%. Vaginal POP-Q points made a cranial shift from mid to late pregnancy, a caudal shift following delivery, and again a cranial shift after 6 weeks postpartum. Postpartum change was present following both vaginal and caesarean deliveries, but was more pronounced following vaginal delivery. The perineal body and genital hiatus became longer from mid to late pregnancy, and shortened after 6 weeks postpartum. At 12 months postpartum all POP-Q points, except cervix, had recovered to baseline in the vaginal delivery group.Conclusions The prevalence of anatomic POP was low in this cohort. There was change in pelvic organ support both during pregnancy and following vaginal as well as caesarean delivery. The short-term ability to recover was good after the first pregnancy and delivery.Keywords Delivery, pelvic organ support, POP, postpartum, pregnancy, primipara.Tweetable Abstract Pelvic organ support changes during pregnancy. A contribution to the risk of POP?

Risk factors for anatomic pelvic organ prolapse at 6 weeks postpartum: a prospective observational study

“…Continuing exclusion criteria were premature delivery prior to 32 weeks of gestation and stillbirth. The women included in the cohort have been shown to be comparable to the total population of nulliparous pregnant women who delivered at the hospital during the inclusion period (n=2621) with regards to age, body mass index (BMI), fetal birth weight and delivery route, but more women in the study sample had university or college education (75.3% compared with 50.8%, P<0.001) (17). The study participants were predominantly of Caucasian ethnicity (96%).…”

“…The clinical examinations were performed at mid pregnancy and at 6 weeks postpartum by two trained gynecologists blinded to previous findings and the obstetric history of the participants. POP-Q was done according to standardized methods previously described in detail (17). Transperineal 3D ultrasound describing LHarea and major LAM injuries was done according to the methods described by Dietz defining major LAM injuries by a defect in the muscle evident in at least three consecutive tomographic slices at and/or above the plane of minimal hiatal dimension (22).…”

“…This study is part of a prospective observational study aiming at describing the natural history of the pelvic floor from mid pregnancy until one year postpartum in a cohort of first time mothers, using the pelvic organ prolapse quantification system (POP-Q) and transperineal three dimensional (3D) ultrasound (15)(16)(17)(18)(19)(20)(21). Data presented from this cohort has shown that pelvic organ support changed both during pregnancy and following delivery.…”

“…Data presented from this cohort has shown that pelvic organ support changed both during pregnancy and following delivery. Anatomic POP (aPOP) defined as POP-Q stage ≥ 2 reached a peak prevalence of nine per cent at six weeks postpartum followed by a recovery to a prevalence of two per cent at one year postpartum (17). In the present study we wanted to study risk factors for having aPOP postpartum.…”

The Influence of Early Exercise Postpartum on Pelvic Floor Muscle Function and Prevalence of Pelvic Floor Dysfunction 12 Months Postpartum

“…Guidelines regarding exercise for postpartum women recommend a gradual commencement or return to physical activity as soon as medically safe (1). Concerns have been raised, however, that starting exercise early in the postpartum period may negatively impact on the already stretched and weakened pelvic floor muscles (PFM) (2)(3)(4). Transperineal ultrasound has shown changes in pelvic organ support and an increase in the area surrounding the pelvic openings (levator hiatus area) during both pregnancy and following vaginal delivery, which suggests reduced support to the pelvic organs (3,4).…”