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The recovery of pelvic organ support during the first year postpartum
Author(s) -
Chen Y,
Li FY,
Lin X,
Chen J,
Chen C,
Guess MK
Publication year - 2013
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.12369
Subject(s) - medicine , gestation , body mass index , obstetrics , pregnancy , gynecology , odds ratio , confidence interval , postpartum period , prospective cohort study , live birth , surgery , genetics , biology
Objective Compare changes in pelvic organ prolapse ( POP ) from 36–38 weeks of gestation to 1 year postpartum after unlaboured cesarean delivery( UCD )and trial of labour ( TOL ). Design Prospective observational cohort study. Setting Wenzhou Third People's Hospital, Wenzhou, Zhejiang, China. Population Nulliparous women undergoing UCD or TOL . Methods Pelvic organ prolapse was assessed at 36–38 weeks of gestation, then at 6 weeks, 6 months and 1 year postpartum, using the Pelvic Organ Prolapse Quantification ( POPQ ) system. Main outcome measures Postpartum POP status in UCD and TOL determined by POPQ measurements over time. Results Points Aa (Ba) determined the final stage assignment in most cases. Stage II POP was present in 35% and 37% of women in UCD and TOL at 36–38 weeks of gestation. After delivery, the likelihood of stage II POP declined during the first year postpartum in the whole cohort. The TOL group was much less likely to recover from stage II POP compared with the UCD group (odds ratio 0.04, 95% confidence interval 0.01–0.18) after adjustment for POP status at 36–38 weeks of gestation, age, first‐trimester body mass index, newborn birthweight, educational level, gravidity and smoking status. With the exception of age, education and gravidity, these covariates were also independent predictors of postpartum POP . Conclusion Factors unique to labour and delivery lead to sustained pelvic floor relaxation postpartum. Pelvic organ prolapse at 36–38 weeks of gestation, and higher first‐trimester body mass index also appear to predict long‐term POP . Further investigation into mechanisms leading to persistent or progressive POP after TOL are warranted. In addition, caution is needed in generalising the findings due to the single‐centre design.