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Predictors for unsuccessful pessary fitting in women with symptomatic pelvic organ prolapse: a prospective study
Author(s) -
Mao M,
Ai F,
Zhang Y,
Kang J,
Liang S,
Xu T,
Zhu L
Publication year - 2018
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 - 10.1111/1471-0528.15260
Subject(s) - pessary , medicine , receiver operating characteristic , area under the curve , gynecology , body mass index , obstetrics , odds ratio , prospective cohort study , surgery
Objective To evaluate the success rate of vaginal pessary fitting and identify the risk factors associated with unsuccessful pessary fitting in a large cohort of patients with symptomatic pelvic organ prolapse ( POP ). Design Prospective observational study. Setting The Department of Obstetrics and Gynaecology, Peking Union Medical College Hospital, Beijing, China. Population Women with symptomatic POP between May 2015 and December 2016 ( n = 343). Methods A successful pessary fitting was defined as a patient fitted with a pessary at the initial fitting and continued use 2 weeks later. The independent samples t ‐test, non‐parametric test, Chi‐square test, Fisher's exact test, logistic regression and receiver operating characteristic curves were used for the data analysis. Main outcome measures The success rate of vaginal pessary fitting and the risk factors associated with unsuccessful pessary fitting. Results 302 patients had successful pessary fitting (88.0% success rate). A higher body mass index [ BMI ; 24.7 ± 3.1 kg/m 2 in the successful group versus 25.7 ± 3.8 kg/m 2 in the unsuccessful group, odds ratio ( OR ) 1.174, 95% CI 1.055–1.307, P = 0.003] and a shorter TVL [8.0 (8–9) cm in the successful group versus 7.0 (6.8–8) cm in the unsuccessful group, OR 0.338, 95% CI 0.223–0.513, P < 0.001) were independent predictors of an unsuccessful pessary fitting. The receiver operating characteristic curve showed that patients with a total vaginal length ( TVL ) less than 7.3 cm had a higher unsuccessful pessary fitting rate (sensitivity = 0.82, specificity = 0.64). Conclusions A higher BMI and shorter TVL were independent predictors of an unsuccessful pessary fitting. Patients with a TVL <7.3 cm are not appropriate candidates for a vaginal pessary. Tweetable abstract A higher BMI and shorter TVL (<7.3 cm) were independent predictors of an unsuccessful pessary fitting.