Pelvic organ support in pregnancy and postpartum

Abstract

The purpose of this study was to evaluate pelvic organ support during pregnancy and following delivery. This was a prospective observational study. Pelvic organ prolapse quantification (POPQ) examinations were performed during each trimester of pregnancy and in the postpartum. Statistical comparisons of POPQ stage and of the nine measurements comprising the POPQ between the different time intervals were made using Wilcoxon's signed rank and the paired t-test. Comparison of POPQ stage by mode of delivery was made using Fisher's exact test. One hundred thirty-five nulliparous women underwent 281 pelvic organ support evaluations. During both the third trimester and postpartum, POPQ stage was significantly higher compared to the first trimester (p<0.001). In the postpartum, POPQ stage was significantly higher in women delivered vaginally compared to women delivered by cesarean (p=0.02). In nulliparous pregnant women, POPQ stage appears to increase during pregnancy and does not change significantly following delivery. In the postpartum, POPQ stage may be higher in women delivered vaginally compared to women delivered by cesarean.

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

“…In our study the women were examined sitting 45°upright, whereas in the other two studies the patient was examined in supine lithotomy position and left lateral position, respectively. 14,16 Although POP-Q is validated for examining women in all three positions, these studies were performed in older, non-pregnant women. [26][27][28][29] The studies comparing dorsal lithotomy position with sitting upright found a higher degree of prolapse in the upright position, whereas we believe this to be opposite in the case of an enlarged uterus.…”

“…[14][15][16][17][18] A study following nulliparous Chinese women found a peak prevalence of anatomic POP in the third trimester of 35-37%, followed by a significant decline in the first year postpartum, although less in women delivered vaginally compared with women delivered by caesarean. 18 In contrast, a study following British women for up to 5 years postpartum found that vaginal delivery was associated with a persistent worsening in mean POP-Q stage, from 0.61 in the second trimester to a peak of 1.23 at 14 weeks postpartum, then 0.97 at 1 year postpartum and 1.06 at 5 years postpartum.…”

“…Studies presenting clinical data addressing these issues are few and their results are conflicting. [14][15][16][17][18] A search on PubMed did not reveal any longitudinal study following the same subjects during pregnancy and onwards throughout the first year postpartum, looking at change in pelvic organ support over time. [14][15][16][17][18] This is a prospective observational study aiming to describe the natural history of pelvic organ support from mid pregnancy to 1 year postpartum using the pelvic organ quantification (POP-Q) system in women having their first child.…”

“…[14][15][16][17][18] A search on PubMed did not reveal any longitudinal study following the same subjects during pregnancy and onwards throughout the first year postpartum, looking at change in pelvic organ support over time. [14][15][16][17][18] This is a prospective observational study aiming to describe the natural history of pelvic organ support from mid pregnancy to 1 year postpartum using the pelvic organ quantification (POP-Q) system in women having their first child. 19 The specific aims of the study were: (1) to estimate the prevalence of anatomic POP in this population; (2) to describe changes in pelvic organ support from mid pregnancy until 1 year postpartum for the total study population; (3) to examine whether delivery route affects changes in pelvic organ support postpartum.…”

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).…”