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Longitudinal study of quantitative changes in pelvic organ support among parous women. American Journal of Obstetrics & Gynecology. Presented at the 38th annual scientific meeting of the American Urogynecologic Society, Providence, RI, Oct. 3–7, 2017.

Auteur·e(s) :

Victoria L. Handa, MD, Joan L. Blomquist, MD, Ms Jennifer Roem, MS, Alvaro Muňoz, PhD

Année de publication :

2017

URL(s) :

http://www.ajog.org/article/S0002-9378(17)32713-8/…
https://doi.org/10.1016/j.ajog.2017.12.214

Résumé (français)  :

Abstract (English)  :

Background

Pelvic organ prolapse is more common among parous (versus nulliparous) women and also more common after vaginal (versus cesarean) birth. However, very little is known about how childbirth affects the course and progression of pelvic organ prolapse across a woman’s lifespan.

Objective

To investigate longitudinal, quantitative changes in pelvic organ support after childbirth, focusing on the impact of vaginal versus cesarean delivery.

Study design

This was a prospective longitudinal cohort study in which parous women were recruited 5-10 years from first delivery and followed annually. Using data from annual Pelvic Organ Prolapse Quantification examinations, we considered changes in vaginal support at the anterior vaginal wall (point Ba), the vaginal apex (point C), and the posterior wall (point Bp). In univariate and multivariable models, we compared pelvic organ support between women who had delivered at least one child vaginally versus those delivered exclusively by cesarean. Other covariates considered included race, age at first delivery, and the size of the genital hiatus (GH). For models of support at Ba and Bp we also considered the independent association with apical support. For women who delivered vaginally, we also considered forceps birth.

Results

1224 women participated for a total of 7055 woman-visits. In multivariable models, vaginal birth was associated with significantly worse support 5 years from first delivery. Also, women with at least one vaginal birth had more rapid worsening of support at C. The width of GH was a significant independent predictor of worse support 5 years from delivery as well as the rate of change over time. In models that controlled for GH, the strength of the impact of vaginal birth was attenuated.

Conclusions

Vaginal birth was associated with worse support 5 years from first delivery and with more rapid deterioration in support at the apex. Above and beyond the impact of vaginal birth, the size of GH may be an independent marker for those at greatest risk of prolapse progression.

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Mots-clés :

➡ accompagnement ; césarienne ; incontinence/prolapsus

Auteur·e de cette fiche :

Bernard Bel — 02 Jan 2018
➡ dernière modification : Bernard Bel — 07 Jan 2018