Skip to main content

Advertisement

SpringerLink
Log in

Pelvic organ support several years after a first birth

  • Original Article
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

Abstract

Introduction and hypothesis

Female pelvic organ prolapse is highly prevalent and childbirth has been shown to be an important risk factor. The study was carried out to observe if pelvic organ support deteriorates over time following a first birth.

Methods

This is a retrospective review using archived data sets of women seen in the context of two prospective perinatal imaging studies. All subjects had undergone a standardised interview, a clinical examination and 4D translabial ultrasound, 3 months and 2–5 years post-partum. Main outcome measures were pelvic organ descent and hiatal area at maximum Valsalva manoeuvre. Means at the two time points were compared using paired Student’s t test. Predictors of change over time in continuous variables were explored using linear modelling methods.

Results

A total of 300 women had at least two postnatal follow-ups. They were first seen on average 0.39 (SD 0.2, range 0.2–2.1) years and again 3.1 (SD 1.5, range 1.4–8) years after the index delivery, with a mean interval of 2.71 (SD 1.5, range 0.7–7.7) years, providing a total of 813 (300 × 2.71) woman-years of observation. On univariate analysis, there was a significant decrease in mobility over time of the bladder neck, bladder, and rectal ampulla (P = < 0.004) and hiatal area (P = 0.012). The degree of improvement was less marked in women with levator avulsion.

Conclusions

A significant reduction in pelvic organ descent and hiatal area was noted over a mean of 2.7 years after a first birth.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Swift SE, Tate SB, Nicholas J. Correlation of symptoms with degree of pelvic organ support in a general population of women: what is pelvic organ prolapse? Am J Obstet Gynecol. 2003;189(2):372–7.

    Article  PubMed  Google Scholar 

  2. Hagen S, Thakar R. Conservative management of pelvic organ prolapse. Obstet Gynaecol Reprod Med. 2012;22(5):118–22.

    Article  Google Scholar 

  3. Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol. 1997;89(4):501–6.

    Article  CAS  PubMed  Google Scholar 

  4. Sung VW, Hampton BS. Epidemiology of pelvic floor dysfunction. Obstet Gynecol Clin N Am. 2009;36(3):421–43.

    Article  Google Scholar 

  5. Ashton-Miller JA, DeLancey JO. On the biomechanics of vaginal birth and common sequelae. Annu Rev Biomed Eng. 2009;11:163.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Dietz H, Wilson P. Childbirth and pelvic floor trauma. Best Pract Res Clin Obstet Gynaecol. 2005;19(6):913–24.

    Article  CAS  PubMed  Google Scholar 

  7. Memon HU, Handa VL. Vaginal childbirth and pelvic floor disorders. Women’s Health. 2013;9(3):265–77.

    Article  CAS  PubMed  Google Scholar 

  8. Dietz H. The aetiology of prolapse. Int Urogynecol J. 2008;19(10):1323–9.

    Article  CAS  Google Scholar 

  9. DeLancey JO. Anatomy and biomechanics of genital prolapse. Clin Obstet Gynecol. 1993;36(4):897–909.

    Article  CAS  PubMed  Google Scholar 

  10. Dietz H, Eldridge A, Grace M, Clarke B. Pelvic organ descent in young nulligravid women. Am J Obstet Gynecol. 2004;191(1):95–9.

    Article  CAS  PubMed  Google Scholar 

  11. Dietz H, Lekskulchai O. Ultrasound assessment of pelvic organ prolapse: the relationship between prolapse severity and symptoms. Ultrasound Obstet Gynecol. 2007;29(6):688–91.

    Article  CAS  PubMed  Google Scholar 

  12. Dietz HP. Prolapse worsens with age, doesn’t it? Aust N Z J Obstet Gynaecol. 2008;48(6):587–91.

    Article  PubMed  Google Scholar 

  13. Swift SE. The distribution of pelvic organ support in a population of female subjects seen for routine gynecologic health care. Am J Obstet Gynecol. 2000;183(2):277–85.

    Article  CAS  PubMed  Google Scholar 

  14. Shek K, Dietz H. Intrapartum risk factors for levator trauma. BJOG. 2010;117(12):1485–92.

    Article  CAS  PubMed  Google Scholar 

  15. Kamisan Atan I, Shek KL, Langer S, Guzman Rojas R, Caudwell-Hall J, Daly JO, et al. Does the Epi-No® birth trainer prevent vaginal birth-related pelvic floor trauma? A multicentre prospective randomised controlled trial. BJOG. 2016;123(6):995–1003.

    Article  CAS  PubMed  Google Scholar 

  16. Bump RC, Mattiasson A, Bø K, Brubaker LP, DeLancey JO, Klarskov P, et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol. 1996;175(1):10–7.

    Article  CAS  PubMed  Google Scholar 

  17. Dietz H. Ultrasound imaging of the pelvic floor. I. Two‐dimensional aspects. Ultrasound Obstet Gynecol. 2004;23(1):80–92.

    Article  CAS  PubMed  Google Scholar 

  18. Dietz H, Shek C, Clarke B. Biometry of the pubovisceral muscle and levator hiatus by three‐dimensional pelvic floor ultrasound. Ultrasound Obstet Gynecol. 2005;25(6):580–5.

    Article  CAS  PubMed  Google Scholar 

  19. Shek KL, Chantarasorn V, Langer S, Phipps H, Dietz HP. Does the Epi-No® Birth Trainer reduce levator trauma? A randomised controlled trial. Int Urogynecol J. 2011;22(12):1521–8.

    Article  PubMed  Google Scholar 

  20. Dietz H, Shek K. Tomographic ultrasound imaging of the pelvic floor: which levels matter most? Ultrasound Obstet Gynecol. 2009;33(6):698–703.

    Article  CAS  PubMed  Google Scholar 

  21. Handa VL, Garrett E, Hendrix S, Gold E, Robbins J. Progression and remission of pelvic organ prolapse: a longitudinal study of menopausal women. Am J Obstet Gynecol. 2004;190(1):27–32.

    Article  PubMed  Google Scholar 

  22. Rahn DD, Ruff MD, Brown SA, Tibbals HF, Word RA. Biomechanical properties of the vaginal wall: effect of pregnancy, elastic fiber deficiency, and pelvic organ prolapse. Am J Obstet Gynecol. 2008;198(5):590.e1–6.

    Article  Google Scholar 

  23. Branham V, Thomas J, Jaffe T, Crockett M, South M, Jamison M, et al. Levator ani abnormality 6 weeks after delivery persists at 6 months. Am J Obstet Gynecol. 2007;197(1):65.e1–6.

    Article  Google Scholar 

  24. Shek K, Chantarasorn V, Langer S, Dietz H. Does levator trauma ‘heal’? Ultrasound Obstet Gynecol. 2012;40(5):570–5.

    Article  CAS  PubMed  Google Scholar 

  25. Abdool Z, Shek KL, Dietz HP. The effect of levator avulsion on hiatal dimension and function. Am J Obstet Gynecol. 2009;201(1):89.e1–5.

    Article  Google Scholar 

  26. Dietz H, Simpson J. Levator trauma is associated with pelvic organ prolapse. BJOG. 2008;115(8):979–84.

    Article  CAS  PubMed  Google Scholar 

  27. Van Veelen G, Schweitzer K, van der Vaart C. Ultrasound imaging of the pelvic floor: changes in anatomy during and after first pregnancy. Ultrasound Obstet Gynecol. 2014;44(4):476–80.

    Article  PubMed  Google Scholar 

  28. Stær-Jensen J, Siafarikas F, Hilde G, Benth JŠ, Bø K, Engh ME. Postpartum recovery of levator hiatus and bladder neck mobility in relation to pregnancy. Obstet Gynecol. 2015;125(3):531–9.

    Article  PubMed  Google Scholar 

  29. Shek KL, Dietz HP. The effect of childbirth on hiatal dimensions. Obstet Gynecol. 2009;113(6):1272–8.

    Article  PubMed  Google Scholar 

  30. Tan L, Shek KL, Atan IK, Rojas RG, Dietz HP. The repeatability of sonographic measures of functional pelvic floor anatomy. Int Urogynecol J. 2015;26(11):1667–72.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Departamento de Fisioterapia, Universidade Federal de Pernambuco, Av. Prof. Moraes Rego, 1235, Cidade Universitária, Recife, Pernambuco, Brazil, CEP:50670-901

    Caroline W. S. Ferreira

  2. Universiti Kebangsaan, Kuala Lumpur, Malaysia

    Ixora K. Atan

  3. University of Sydney, Sydney, New South Wales, Australia

    Andrew Martin & Hans Peter Dietz

  4. Western Sydney University, Sydney, New South Wales, Australia

    Ka Lai Shek

Authors
  1. Caroline W. S. Ferreira
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ixora K. Atan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Andrew Martin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ka Lai Shek
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hans Peter Dietz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Caroline W. S. Ferreira.

Ethics declarations

Conflicts of interest

Professor Ferreira received a Scholarship from the Brazilian Government: CAPES - BEX 10255/13-3. H.P. Dietz received a grant from the Australian Women and Children’s Research Foundation (OZWAC). H.P. Dietz and K.L. Shek have received unrestricted educational grants from GE. None of the other authors has any conflicts of interest to declare.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ferreira, C.W.S., Atan, I.K., Martin, A. et al. Pelvic organ support several years after a first birth. Int Urogynecol J 28, 1499–1505 (2017). https://doi.org/10.1007/s00192-017-3297-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-017-3297-4

Keywords

Search

Navigation