Prevalence and risk factors for pelvic organ prolapse 20 years after childbirth: a national cohort study in singleton primiparae after vaginal or caesarean delivery

Abstract

Objective To investigate prevalence and risk factors for symptomatic pelvic organ prolapse (sPOP) and sPOP concomitant with urinary incontinence (UI) in women 20 years after one vaginal delivery or one caesarean delivery.Design Registry-based national cohort study.Setting Women who returned a postal questionnaire in 2008 (response rate 65.2%).Population Singleton primiparae with a birth in 1985-88 and no further births (n = 5236).Methods The SWEPOP study used validated questionnaires about sPOP and UI.Main outcome measures Prevalence rate and risk of sPOP with or without concomitant UI.Results Prevalence of sPOP was higher after vaginal delivery compared with caesarean section (14.6 versus 6.3%, odds ratio [OR] 2.55; 95% confidence interval [95% CI] 1.98-3.28) but was not increased after acute compared with elective caesarean section.Episiotomy, vacuum extraction and second-degree or more laceration were not associated with increased risk of sPOP compared with spontaneous vaginal delivery. Symptomatic POP increased 3% (OR 1.03; 95% CI 1.01-1.05) with each unit increase of current BMI and by 3% (OR 1.03; 95% CI 1.02-1.05) for each 100 g increase of infant birthweight. Mothers £160 cm who delivered a child with birthweight ‡4000 g had a doubled prevalence of sPOP compared with short mothers who delivered an infant weighing <4000 g (24.2 versus 13.4%, OR 2.06; 95% CI 1.19-3.55). Women with sPOP had UI and UI > 10 years more often than women without prolapse. ConclusionThe prevalence of sPOP was doubled after vaginal delivery compared with caesarean section, two decades after one birth. Infant birthweight and current BMI were risk factors for sPOP after vaginal delivery.

Knowledge on risk factors of uterine prolapse among reproductive age group women of Bajrabarahi Municipality of Lalitpur, Nepal

“…10,11 Adolescent pregnancy, lack of rest during and immediately after pregnancy -including carrying heavy loads, improper birthing practices used by unskilled birth attendants, poor nutrition, frequent pregnancies and pregnancies close together due to lack of access to contraception are major risk factors associated with UP. 4,7,12,13 In Nepal, child marriage and adolescent pregnancy are high among rural females. 14 According to Nepal Demographic and Health Survey (2011) reflects that of the 29.1% of adolescent girls reporting recent sexual activity, 28.8% were married.…”

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

“…[10][11][12] Findings showing that parous women have a higher prevalence of POP than nulliparous women has led to the perception that POP is a long-term effect of an injury acquired during vaginal childbirth; however, the fact that caesarean delivery is not fully protective for the development of POP later in life might indicate that not only vaginal delivery but also pregnancy itself can induce persistent changes in pelvic organ support. 13 Knowledge about the short-term consequences of pregnancy and delivery on pelvic organ support, and furthermore the capacity for recovery postpartum, is scarce. Studies presenting clinical data addressing these issues are few and their results are conflicting.…”

Mechanical stress influences the viability and morphology of human parametrial ligament fibroblasts

“…Pregnancy, childbirth, obesity and constipation, which may lead to the increase of abdominal pressure, are considered to be important risk factors for POP (1)(2)(3)(4); mechanics serve a vital role in the incidence of POP. Further studies suggest that the occurrence of POP may be associated with an imbalance of the oxidation-reduction equilibrium in vivo (5,6).…”