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

Reimers, C. D.; Siafarikas, Franziska; Stær-Jensen, Jette; Småstuen, Milada Cvancarova; Bø, Kari; Engh, Marie Ellstrøm

doi:10.1007/s00192-018-3650-2

Cited by 29 publications

(24 citation statements)

References 31 publications

(34 reference statements)

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“…Of the 19 studies on FI, including flatal incontinence, nine studies scored moderate for risk of bias and were included for data extraction (see Supporting information, Table ) 19,27,30,32,36,38,44‐46 and 10 studies were excluded because of high risk of bias. On the outcome POP, of the six included studies, four scored high risk of bias and two scored moderate risk of bias, indicating that two were eligible for data extraction (see Supporting information, Table ) 47,48 …”

Section: Resultsmentioning

confidence: 99%

“…Only two eligible studies reported on risk factors for POP with a short‐term follow‐up period 47,48 . Cesarean section was the only risk factor that could be pooled (OR 0.39, 95% CI 0.14‐1.08).…”

Section: Resultsmentioning

confidence: 99%

“…They reported that a small population in their cohort smoked (n=6) and suggested this reduction in risk could possibly be by chance 47 . Significant risk factors from Reimers et al (n=284) were a more caudal position of the anterior vaginal wall (point Ba measured with the POP‐Q) at gestation week 21 (OR 2.45, 95% CI 1.29‐4.67), a longer distance from the meatus urethra to the anus (Gh + Pb measured with the POP‐Q) (OR 1.58, 95% CI 1.05‐2.38), a more distensible levator ani muscle (measured by calculating the difference in levator hiatus area from rest to valsalva [in cm 2 ] with transperineal ultrasound) at gestation week 21 (OR 1.13, 95% CI 1.03‐1.23), and an episiotomy (OR 19.84, 95% CI 6.18‐63.73) 48 …”

Section: Resultsmentioning

confidence: 99%

“…Significant pooled risk factors that are found to be associated with FI postpartum are: FI during pregnancy, maternal age >35 years, prenatal BMI >30 kg/m 2 , an instrumental vaginal delivery, a spontaneous vaginal delivery, oxytocin augmentation, and newborn birthweight >4000 g 19,27,30,38,45,46,49 . Only the factor cesarean section could be pooled for POP but was not a significant protective factor short‐term postpartum 47,48 …”

Section: Discussionmentioning

confidence: 99%

“…For the mode of delivery there are also differences seen in consequences for UI, FI, and POP. A cesarean section strongly decreases the risk of UI, but does not offer protection against FI and POP 19,26‐34,37,38,40,41,47,48 . However, women undergoing a spontaneous vaginal delivery do not have an increased risk for UI, evaluated by 11 studies (n = 18 057), but do for FI, evaluated by four studies (n = 10 708) 19,25,26,28‐34,37,38,40,41,49 .…”

Section: Discussionmentioning

confidence: 99%

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Pregnancy‐ and obstetric‐related risk factors for urinary incontinence, fecal incontinence, or pelvic organ prolapse later in life: A systematic review and meta‐analysis

Hage-Fransen¹,

Wiezer²,

Otto

et al. 2020

Acta Obstet Gynecol Scand

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Introduction Risk factors for pelvic floor disorders are often related to pregnancy and delivery. Consistent evidence is needed to develop prevention strategies targeting risk factors. The objective of this study is to identify which pregnancy‐ and/or obstetric‐related risk factors can predict urinary incontinence, fecal incontinence, or pelvic organ prolapse later in life by means of a systematic review and meta‐analysis. Material and methods Systematic review Prospero number: CRD42019131758. Literature searches of PubMed, EMBASE, CINAHL, and Cochrane Library were conducted according to PRISMA guidelines (April 2020). Prospective cohort studies describing more than two pregnancy‐ and/or obstetric‐related risk factors on urinary incontinence, fecal incontinence (including flatal incontinence), or pelvic organ prolapse were eligible. Risk of bias was assessed (using Quality In Prognosis Studies [QUIPS]). Studies with high risk of bias were excluded. Data were extracted and checked for accuracy with the CHARMS checklist. Sub‐groups were used to distinguish between a short‐ and long‐term follow‐up period: <18 months (shortterm) and >18 months (long‐term) postpartum. Odds ratios were calculated from reported prevalence rates. Log odds ratios were calculated using SPSS v.24. Variables were pooled using RevMan5. Results Data were extracted from nineteen studies for urinary incontinence, nine for fecal incontinence, and two for pelvic organ prolapse. Multivariate analysis was not possible because of the heterogeneity of the population and outcome measures. Pooled univariate risk factors for urinary incontinence were: urinary incontinence during pregnancy, instrumental vaginal delivery, episiotomy, tears, and constipation. Pooled univariate risk factors for fecal incontinence were: fecal incontinence during pregnancy, maternal age over 35 years, prenatal body mass index over 30 kg/m2, instrumental vaginal delivery, a spontaneous vaginal delivery, oxytocin augmentation, and when the weight of the newborn was more than 4000 g. Both studies for pelvic organ prolapse had a short‐term follow‐up period and cesarean section was the only risk factor that could be pooled. Conclusions Pregnancy‐ and obstetric‐related risk factors predicting pelvic floor disorders postpartum are multifactorial and differ between pelvic floor disorders. The strongest risk factor for incontinence later in life was incontinence during pregnancy. Better quality research with long‐term follow up is needed on this topic.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Pregnancy‐ and obstetric‐related risk factors for urinary incontinence, fecal incontinence, or pelvic organ prolapse later in life: A systematic review and meta‐analysis

Hage-Fransen¹,

Wiezer²,

Otto

et al. 2020

Acta Obstet Gynecol Scand

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Longitudinal Study of Pelvic Floor Characteristics Before, During, and After Pregnancy in Nulliparous Women

Lakovschek

Trutnovsky

Obermayer–Pietsch

et al. 2021

J of Ultrasound Medicine

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Objectives To investigate the changes in the pelvic floor before, during, and after pregnancy in the same collective of nulliparous women. Methods In a prospective observational pilot study between April 2015 and June 2019 in nulliparous women with planned pregnancy, we used the pelvic organ prolapse quantification (POP‐Q) system; a 2‐dimensional (2D) sonography to investigate the bladder neck, cervix, and anorectal junction positions; and a 3D/4D sonography to measure the hiatus of the levator ani muscle (LH area) during Valsalva maneuver. Five visits were planned: 1 before, 3 during, and 1 visit after pregnancy. Results Twenty‐four women participated in the study. We achieved a minimum of 2 visit measurements from 10 women who became pregnant. The LH area decreased during the first trimester and then increased until the third trimester. Postpartum, the LH area reached the prepregnancy state. We observed changes in the bladder neck mobility, bladder neck position, cervix, and anorectal junction from the first trimester. Postpartum, the bladder neck mobility was higher, and the position of the bladder neck and anorectal junction was lower than before pregnancy. We observed no remarkable changes in the POP‐Q state during pregnancy. Conclusion This was the first study to investigate pelvic floor characteristics in the same collective before, during, and after pregnancy. We observed pelvic floor changes from the prepregnancy state to the first trimester to postpartum. The study results need to be confirmed in a larger study.

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Surgical Repair of the Genital Hiatus: A Narrative Review

2021

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

Abstract: Prelabor differences in the pelvic floor rather than obstetrical events were risk factors for aPOP at 6 weeks postpartum.

Cited by 29 publications

References 31 publications

Pregnancy‐ and obstetric‐related risk factors for urinary incontinence, fecal incontinence, or pelvic organ prolapse later in life: A systematic review and meta‐analysis

Pregnancy‐ and obstetric‐related risk factors for urinary incontinence, fecal incontinence, or pelvic organ prolapse later in life: A systematic review and meta‐analysis

Longitudinal Study of Pelvic Floor Characteristics Before, During, and After Pregnancy in Nulliparous Women

Surgical Repair of the Genital Hiatus: A Narrative Review

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