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

Abstract

Objective: Identify risk factors for postpartum anatomic pelvic organ prolapse (aPOP) by comparing women with and without aPOP at six weeks postpartum with respect to pelvic floor measurements antepartum and obstetrical characteristics. Design: Prospective observational cohort study including nulliparous pregnant women Setting: Norwegian university hospital Methods: Participants underwent clinical examinations including pelvic organ prolapse quantification system (POP-Q) and transperineal ultrasound at gestational week 21 and at six 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. Main outcome measures: The dependent variable was aPOP defined as POP-Q stage ≥ 2 at six 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 six weeks postpartum. Results: A larger LHarea, a more distensible LAM, a longer distance from the meatus urethra to anus (Gh+Pb) and a more caudal position of the anterior vaginal wall (Ba) at mid pregnancy were risk factors for aPOP at six weeks postpartum, while delivery route and presence of major LAM injuries were not. Conclusion: Prelabour differences in the pelvic floor rather than obstetrical events were risk factors for aPOP at six weeks postpartum.