Risk Of Pelvic Organ Prolapse Research Articles

Relationship Between Maternal Age at First Delivery and Subsequent Pelvic Organ Prolapse.

To determine the relationship between age at first delivery and subsequent risk of pelvic organ prolapse. We performed a retrospective cross-sectional study using the National Health and Nutrition Examination Survey data from 2005 to 2012. Our primary outcome was self-reported prolapse. Survival analyses and Cox proportional hazard models were used to estimate parous women's risks of reporting prolapse in terms of time since first delivery, adjusting for parity, body mass index, prior hysterectomy, ethnicity, and education. We performed subgroup analyses on women with at least 1 vaginal delivery and those with only cesarean deliveries. The survey-weighted prevalence of prolapse was 2.82%. A total of 6203 women, 79% of all parous women surveyed, reported age at first delivery. Kaplan-Meier curves were different for women based on age at first delivery (P = 0.034). For each year increase in age at first delivery, there was a 6% increase in the rate of developing prolapse (adjusted hazard ratio, 1.06; 95% confidence interval, 1.01-1.11; P = 0.011). Compared with a woman who was 20 years at her first delivery, someone who was 30 years had 1.79 times the risk, while at 40 years the risk was 3.21 times. Among women with at least 1 vaginal delivery, the same relationship was found (adjusted hazard ratio, 1.06; 95% confidence interval, 1.01-1.12; P = 0.019). However, this was not significant for women with only cesarean deliveries (P = 0.367). Older age at the time of first delivery was associated with a higher risk of subsequent prolapse. These results should be interpreted with caution given the limitations of cross-sectional survey data.

Collagen I and collagen III polymorphisms in women with pelvic organ prolapse.

Verify the presence of the single nucleotide polymorphisms rs1800012 of the collagen I (COL1A1) and rs1800255 of the collagen III (COL3A1) genes and their association with pelvic organ prolapse (POP) in Brazilian women and to determine risk factors for POP. We assessed 826 postmenopausal women divided into POP (stages III and IV) and control groups (stages 0 and I) by examination and peripheral blood sample collection. DNA sequences of interest were analyzed by real-time reverse-transcriptase polymerase chain reaction. We used logistic regression analyses, recessive and codominance models of inheritance, and P < .05 for significance. Six-hundred and thirty-four postmenopausal women were included: 348 (54.8%) POP cases and 286 (45.1%) controls. The frequencies of GG, GA, and AA genotypes for COL1A1 were 69.12%, 20.24%, and 10.59% in POP group and 71.79%, 20%, and 8.21% in controls; GG, GT, and TT for COL3A1 were 37.54%, 59.53%,and 2.93% in POP group and 36.24%, 60.14%, and 3.62% in controls. There were no genotypic or allelic association with POP phenotype that link both SNPs rs1800012 and rs1800255 to increased risk of POP. Vaginal delivery (odds ratio [OR] = 13; 95% confidence interval [CI] [4.00-47.08]), POP family history (OR = 3.1; 95% CI [1.49-6.50]), diabetes mellitus (OR = 2.3; 95% CI [1.08-5.21]), number of pregnancies (OR = 1.2; 95% CI [1.05-1.36]), and age (OR = 1.1; 95% CI [1.09-1.19]), were variables of increased risk for POP (P < .05 for all). Our study suggests lack of association between DNA polymorphisms rs1800012 of COL1A1 and rs1800255 of COL3A1 with advanced POP. Vaginal delivery, POP family history, diabetes mellitus, number of pregnancies, and age are risk factors for POP.

Common variants in LAMC1 confer risk for pelvic organ prolapse in Chinese population

BackgroundPelvic organ prolapse (POP) affects around 15% of postmenopausal women in China. Although it has been widely accepted that genetic variants could confer risk for POP, the genetic susceptibility variants remain largely unknown. Previous studies indicated that LAMC1, which encodes the laminin gamma 1 chain and is critical for extracellular matrix, might be a susceptibility gene for POP. The study is to test the correlation of common variants across the LAMC1 gene with POP susceptibility in Chinese population.MethodsA total of 396 individuals, including 161 unrelated patients of POP and 235 healthy controls, were recruited. Ten SNPs, including rs20558, rs20563, rs10911193, rs6424889, rs10911241, rs3768617, rs12073936, rs729819, rs10911214 and rs869133, of LAMC1, were genotyped using standard Sanger sequencing. The UNPHASED program (version 3.1.5) was used to analyze the genotyping data for allelic and genotypic associations.ResultsSNP rs10911241 was significantly associated with POP risk (χ2 = 10.70, P = 1.1 E-03). The minor allele (rs10911241-G) carriers exhibited an increased risk of the disease (OR = 1.71, 95% CI = 1.24–2.36).ConclusionAssociation of LAMC1 with POP risk in Chinese population strongly supported the involvement of LAMC1 in POP development.

Post-cystectomy Enterocele: A Case Series and Review of the Literature

ObjectiveTo present a case series and literature review on post radical cystectomy (RC) pelvic organ prolapse (POP) to heighten awareness of the symptoms, imaging findings, and risk factors associated with this complication and discuss opportunities for prevention. Women with muscle invasive bladder cancer undergo RC with anterior exenteration, significantly disrupting the pelvic floor. These women are at risk for POP. MethodsWe present 4 cases of high-grade POP in women who underwent RC for bladder cancer. We reviewed the literature by conducting a Boolean search in PubMed with the terms “(“radical cystectomy”) AND (“enterocele” OR “pelvic organ prolapse” OR “rectocele” OR “vaginal vault prolapse”).” ResultsAll 4 women reported a bulge sensation in the vagina and physical exam confirmed POP. Three had radiographic findings consistent with high-grade enterocele at rest. Three experienced prolonged intra-abdominal pressure rise post-RC that may have further weakened pelvic floor support, while the fourth had a history of surgery for high-grade POP. Nine articles on POP following RC were identified. Four focused on treatment and 3 focused on prevention. ConclusionAdministration of a single validated question would have identified all 4 cases of postoperative enterocele and is sensitive to detect most women who are experiencing POP. Attention to the pelvic floor on cross-sectional imaging with identification of features that indicate POP, such as herniation of intestinal contents below the pubo-coccygeal line, will identify and/or confirm high-grade enterocele. Familiarity with risk factors for POP and identification of weakened vaginal wall support opens up the opportunity for prevention.

The Role of MRI in the Diagnosis of Pelvic Floor Disorders.

This article provides an overview of MRI as a dynamic imaging modality as well as recent updates on the role of MRI in the evaluation of female pelvic floor disorders, including pelvic organ prolapse (POP), rectal prolapse, and defecatory dysfunction. Pelvic floor disorders in women are common, and demand for treatment is high. Recently, multidisciplinary guidelines for dynamic MRI have been published to reflect this need. Despite criticisms that MRI is an expensive modality, cost-analysis studies are demonstrating utility for MRI in surgical decision-making trees for patients at risk for treatment failure after POP repairs. Novel measures such as anterior pelvic area and levator volumes are being used to predict and study patients with and at risk for POP. Recent standardized radiographic guidelines as reviewed in this paper will likely lead to improved reproducibility of dynamic MRI techniques across institutions, making complex pelvic floor assessment increasingly accessible to patients while creating opportunities for novel and collaborative research.

The Influence of Early Exercise Postpartum on Pelvic Floor Muscle Function and Prevalence of Pelvic Floor Dysfunction 12 Months Postpartum

There is limited knowledge on how exercise impacts the pelvic floor muscles (PFM) and prevalence of stress urinary incontinence (SUI) and pelvic organ prolapse (POP) postpartum. The purpose of this study was to investigate whether early onset of general exercise postpartum negatively affects the PFM and/or increases the risk of SUI and POP 12months postpartum. This study used a prospective cohort design. At 6weeks postpartum, 57 women classified as exercisers (exercising ≥3 times at ≥30min/wk) were compared with 120 nonexercisers (mean age=29 years, SD=4.3). Manometry was used to measure vaginal resting pressure, PFM strength, and PFM endurance, and symptoms of SUI and POP were assessed using questionnaires. Data were presented as standardized beta coefficients (B) and odds ratios (OR). No differences were found between exercisers (n=57) and non-exercisers (n=120) at 6weeks postpartum on vaginal resting pressure (B=-0.04 [95% CI=-3.4 to 2.1]), PFM strength (B=0.03 [95% CI=-4.7 to 7.4]), PFM endurance (B=-0.02 [95% CI=-59 to 46]), or symptoms of SUI (OR=0.51 [95% CI=0.25 to 1.1]) or POP (OR=0.62 [95% CI=0.26 to 1.5]) measured at 12months postpartum. Adjusting for covariates, women with body mass index between 25 and 29.9 and>30 were more likely to report SUI 12months postpartum (OR=2.2 [95% CI=1.0 to 4.7] and OR=3.3 [95% CI=1.2 to 9.4], respectively). Women with physically strenuous occupations were more likely to report POP 12months postpartum (OR=3.0 [95% CI = 1.2 to 7.3]). This study suggests that regular exercise 6weeks postpartum has no negative effect on PFM function or on SUI or POP. Being overweight, however, was associated with more SUI, and women with physically strenuous occupations reported more POP. Results from this study suggest that first-time mothers should be encouraged to start general exercise within the first 6weeks after giving birth. Women at risk for PFD should be advised accordingly and potentially modifiable risk factors should be addressed prior to delivery. First-time mothers are encouraged to talk with a physical therapist about starting regular general exercise in the early postpartum weeks. Health care providers should advise patients on possible preventive measures for women at risk for PFD.

Risk of pelvic organ prolapse treatment based on extended family history

Family history of pelvic organ prolapse among first-degree relatives is an established risk factor for pelvic organ prolapse; however, consideration of the constellation of family history that extends to distant relationships allows for more accurate determination of risk and may improve pelvic organ prolapse risk prediction estimates. The purpose of this study was to assess risk for pelvic organ prolapse treatment based on varying family histories of pelvic organ prolapse and included number and types of affected relatives, ages of relatives at pelvic organ prolapse treatment, and whether the family history is of maternal or paternal origin. This was a retrospective, population-based study that involved the Utah Population Database, which is a population resource that includes extensive genealogy information linked to medical records. The study population included 453,522 total women: 4628 women with a diagnosis of treated (surgical or pessary) pelvic organ prolapse and their 15,530 first-degree relatives; 33,782 second-degree relatives, and 66,469 third-degree relatives. We estimated relative risk of treated pelvic organ prolapse based on specific family history constellations. Relative risk estimates increased with a family history of increasing numbers of treated first-degree relatives with pelvic organ prolapse (first-degree relatives, ≥1 [relative risk, 2.36; 95% confidence interval, 2.15-2.58], first-degree relatives, ≥2 [relative risk, 3.79; 95% confidence interval, 2.65-5.24], and first-degree relatives, ≥3 [relative risk, 6.26; 95% confidence interval, 1.29-18.30]). Having a family history of ≥3 affected third-degree relatives (eg, first cousins) and no affected first- or second-degree relatives was similar in risk to having 1 affected first-degree relative. Relative risk estimates decreased with increasing age of treatment for first-degree family members. Risks in individuals with a positive maternal family history for pelvic organ prolapse were consistently higher than risks in individuals with equivalent paternal family history, but paternal inheritance still played a role. Approximately 4% of the total studied female population was found to have a >2-fold risk of being treated for pelvic organ prolapse and is considered high-risk based on their family history. We provide estimates for treated pelvic organ prolapse based on an extensive family history of pelvic organ prolapse using a large population-based sample. Risk for treated pelvic organ prolapse increased with increasing numbers of affected close and distant female relatives, earlier age of pelvic organ prolapse treatment in relatives, and maternal inheritance. These risk estimates may be useful for genetic studies and investigation of risk reduction strategies in those at highest risk for pelvic organ prolapse.

Elastin genetic point mutation and the risk of pelvic organ prolapse

Aim: A missense mutation in the elastin gene (g28197A &gt; G) is associated with an increased risk for inguinal hernias. Due to the shared epidemiological and pathophysiological features between pelvic organ prolapse (POP) and inguinal hernias, the authors hypothesized that a similar association exists between elastin gene polymorphism and POP. Materials and Methods: Patients of Ashkenazi Jewish origin with advanced (stage III-IV) POP (as assessed by POP-Q) and healthy controls were compared for the presence of the elastin gene g28197A &gt; G missense mutation. Results: The missense mutation in the elastin gene was not found in neither the study or the control group. Conclusion: The elastin gene g28197A &gt; G missense mutation was not found to be associated with an increased risk for POP.

Symptoms of pelvic organ prolapse in women who lift heavy weights for exercise: a cross-sectional survey.

The aim of the study was to determine the prevalence of symptoms of pelvic organ prolapse (POP), defined as the sensation of a vaginal bulge, and associated risk factors in women over 18years of age who lift light (≤15kg), moderate (16-50kg), and heavy (>50kg) weights for exercise, and those who do not lift weights for exercise. Women completed an online survey about risk factors for pelvic floor dysfunctions, physical activity history, and pelvic floor symptoms. A question about a vaginal bulge sensation from the validated Pelvic Floor Distress Inventory (PFDI-20) was used to indicate symptoms of POP. Relationships between symptoms of POP and possible risk factors were assessed through logistic regression analysis. Of the 3,934 survey participants, the total prevalence of POP symptoms was 14.4% (n = 566). Category of weight lifted, age, vaginal parity, history of constipation or hemorrhoids, and family history of POP were significantly associated with symptoms. Physically active women lifting weights ≤15kg were more likely to report symptoms of pelvic organ prolapse than women lifting weights greater than 50kg (59.7% vs 15.2%; adjusted odds ratio 2.1; 95% confidence interval 1.7-3.4). There was no relationship between POP symptoms and body mass index, forceps delivery, cesarean section, hysterectomy, or menopausal status. Physically active women who lift heavy weights for exercise do not have an increased prevalence of POP symptoms. Advice on the contribution of heavy weight lifting as part of a physical activity regime to the pathophysiology of POP requires further investigation.

Postpartum pelvic organ prolapse in women with cesarean section at different time during delivery

Objective: To study and analyze the incidence of pelvic organ prolapse (POP) in women who underwent cesarean section. Methods: A cross-sectional study was conducted. The clinical data of the women who underwent regular antepartum examination and cesarean delivery in Peking University People's Hospital from January 2019 to June 2019 were collected, including the cervical dilatation. The incidence of POP was analyzed. Results: (1) A total of 345 women met the inclusion criteria, with cervical dilatation of 0-10 cm before cesarean section, the cervix was not dilatated in 58.6% (202/345) of the women, and the cervix was fully dilatated in 2.9% (10/345) of the women. There were 109 cases of POP stage Ⅰ or above, 13 cases of POP stage Ⅱ, and no stage Ⅲ or Ⅳ. The incidence of POP was 31.6% (109/345). (2) Statistical analysis showed that the cervical dilatation of the POP group was significantly larger than that of the non-prolapse group (median: 1.0 vs 0 cm;Z=-2.227, P=0.026). The risk of POP of vaginal trial-birth transfer to cesarean section was higher than that of elective cesarean section [42.4% (36/85) vs 28.1% (73/260), P=0.014]. However, the further analysis of Spearman correlation between cervical dilatation, elective cesarean section and POP, as well as the receiver operating characteristic curve showed that the correlation and prediction value were poor. Conclusion: Elective cesarean section has a certain protective effect on postpartum prolapse, but the protective effect of vaginal trial-birth transfer to cesarean section on pelvic floor is weakened.

Commentary on: Identification of pelvic organ prolapse risk susceptibility gene SNP locus in Xinjiang women

Commentary on: Identification of pelvic organ prolapse risk susceptibility gene SNP locus in Xinjiang women

Pelvic Floor Organ Prolapse After Radical Cystectomy in Patients With Uroepithelial Carcinoma.

The aim of this study was to identify whether women who undergo a radical cystectomy for uroepithelial carcinoma are at increased risk of pelvic organ prolapse after surgical treatment. A retrospective cohort study compared female subjects who had undergone a radical cystectomy for uroepithelial carcinoma, as identified through an institutional cancer survivor database, with subjects who presented to the Pelvic Health and Continence Clinic with symptoms of either uterovaginal prolapse or urinary incontinence. Demographic data were collected regarding risk factors for prolapse, and study subjects were asked to complete a Pelvic Organ Prolapse Distress Inventory (POPDI-6). Data were collected through retrospective chart review. The primary outcome is difference in the POPDI-6 between the groups. Statistical evaluation of responses was performed, with analysis of variance used to compare the questionnaire scores between groups and correction for risk factors with χ2 tests, with a P value of 0.05 selected for statistical significance. There were 36 postcystectomy subjects who responded to the survey, 37 subjects in the prolapse group, and 44 subjects in the incontinence group. With correction for age, body mass index, and number of vaginal deliveries, the postcystectomy group reported significantly lower scores on the POPDI-6 than both the prolapse group (P < 0.0001) and the incontinence group (P = 0.0003). Radical cystectomy for uroepithelial carcinoma does not correlate with an increased risk of patient-reported symptoms of pelvic organ prolapse.

Identification of pelvic organ prolapse risk susceptibility gene SNP locus in Xinjiang women.

Susceptibility genes play an important role and have regional specificity in the occurrence of pelvic organ prolapse (POP). This study aims to identify POP susceptibility genes and their loci in ethnic minorities with different genetic backgrounds from Xinjiang in China, providing a theoretical basis for early POP diagnosis, treatment and prevention. Genomic DNA from peripheral blood of 196 patients was prepared; there were 88 POP patients and 108 non-pelvic floor dysfunction patients. We selected 16 different susceptibility gene single-nucleotide polymorphism (SNP) loci, which had been identified as associated with POP risk by researchers in other countries, and carried out genotyping through the Snapshot reaction. The allele and genotype frequencies, odds ratio (OR) and 95% confidence interval (CI) were analyzed using SPSS 17.0 software. The genotypic and allelic distributions demonstrated significant differences between the patients and the control subjects in the group of minority women, details are as follows: ESR1 rs17847075 AG: OR = 2.738, 95% CI = 1.067-7.025, P = 0.041; ESR1 rs2234693 TC: OR = 2.99, 95% CI = 1.163-7.684, P = 0.024; ZFAT rs1036819 CC: OR = 10.286, 95% CI = 1.158-91.386, P = 0.036; allele C: OR = 2.212, 95% CI = 1.146-4.269; P = 0.02; FBLN5 rs12589592 AA: OR = 0.111, 95% CI = 0.013-0.952, P = 0.029; allele A: OR = 0.482, 95% CI = 0.254-0.913, P = 0.028. ESR1 rs17847075 genotype AG in the dominant model (P = 0.008) or heterozygous model (P = 0.045), ESR1 rs2234693 genotype TC in the dominant model (P = 0.008) or heterozygous model (P = 0.028), and ZFAT rs1036819 genotype CC and allele C in the recessive model (P = 0.042) were significantly associated with POP risk in Xinjiang woman.

Pelvic organ prolapse surgery after native tissue vault suspension at hysterectomy—A prospective cohort study

ObjectiveThe effect of prophylactic vaginal vault suspension during hysterectomy in prevention of subsequent development of pelvic organ prolapse (POP) is unknown. We aimed to investigate incidences and risk of POP surgery in women who had undergone hysterectomy on benign indication with and without prophylactic suspension. Study designWe linked the national clinical Danish Hysterectomy and Hysteroscopy Database (DHHD) to administrative registries to assess data on all total hysterectomies (1 May 2012 to 31 December 2014), suspension methods, age, POP surgery, births, obstetric complications, prescriptions, socioeconomic- and vital status. Women undergoing total hysterectomy on non-prolapse and benign indication with no prior POP surgery were included and followed from hysterectomy to POP surgery, death/emigration or end of study period (maximum 2 years). Descriptive statistics, cumulative incidence curves and multivariable Cox proportional hazard models were fitted to assess the associated risk of POP in relation to prophylactic suspension. ResultsWe included 7625 patients undergoing total hysterectomy; of these, 6538 (85.7%) were registered with prophylactic suspension during hysterectomy and 1087 (14.3%) women were specifically registered with no suspension in the DHHD. At baseline, women undergoing hysterectomy with suspension were on average 47.1 years of age (standard error SE 0.1) compared to 48.4 years (SE 0.3) in women with no suspension (p-value <0.0001). Moreover, women with suspension differed from their counterparts with no suspension with respect to geographical site of hysterectomy, hysterectomy method, parity and income. The cumulative risk of POP surgery after two years follow-up was 0.9% and 0.5% in the suspension group and the no suspension group, respectively. In the adjusted analysis, we found no association of prophylactic suspension and risk of POP surgery, hazard ratio (HR) = 2.1 (95% confidence interval (CI) 0.8–5.3, p-value 0.13). ConclusionOf all women undergoing hysterectomy for benign indication, 0.84% (N = 64) were surgically treated for POP. At two-year follow-up, there was no association between prophylactic vaginal vault suspension at time of hysterectomy and subsequent POP surgery.

Study of the polymorphism rs3025058 of the MMP-3 gene and risk of pelvic organ prolapse in Brazilian women.

ObjectiveTo analyze the polymorphism -1171 5A / 6A rs3025058 of the MMP-3 gene and the risk for pelvic organ prolapse (POP).Study DesignThis is a cohort study. All patients attended the Urogynecology and Vaginal Surgery Section of the FMABC, from 2014 to 2016 and they were randomly recruited by the researchers at the first medical appointment. We selected 112 patients with symptomatic POPs and 180 patients with normal pelvic floors. The single nucleotide polymorphism (SNP) 5A / 6A of MMP-3 was determined by polymerase chain reaction (PCR) and analysis of the restriction fragments in both groups. Chi-squared test was used to compare the frequencies of polymorphisms between the groups. For those characteristics with statistical relevance, the crude odds ratio (OR) and its respective 95% confidence intervals were calculated; and, by logistic regression, were adjusted for each of the other characteristics, obtaining the adjusted OR. Hardy-Weinberg gene balance was determined using Pearson's Chi-squared test. Values of p < 0.05 were considered statistically significant.ResultsLogistic regression of factors associated with genital prolapse showed that age (adjusted OR = 11.89, 95% CI, 3.53–40) and home delivery (adjusted OR = 9.645, 95% CI, 3.35–27.7) remained risk factors for genital prolapse in the sample studied. There was no statistically significant difference between the groups in the distribution of genotypes, even after calculating the contribution of the 5A recessive allele in the aggregated genotypes (5A / 5A + 5A / 6A).ConclusionThe polymorphism -1171 5A / 6A rs3025058 of the MMP-3 gene was not associated with the risk for POP. Age and home delivery were significantly associated with increased risk for the disease.

Polymorphism rs1800255 from COL3A1 gene and the risk for pelvic organ prolapse.

Genetic variations of type III collagen may compromise the supportive structures of the female pelvic floor and consequently favor pelvic organ prolapse. The single nucleotide polymorphism G/A rs1800255 located in the coding region for type III collagen (COL3A1) was evaluated as a risk factor for pelvic organ prolapse. A single-center prospective cohort study including women with clinical diagnosis of stage III and IV prolapse (POP group) and prolapse stage 0 or I (control group). Sociodemographic, clinical data and obstetric history were retrieved by physician interview. DNA including the rs1800255 polymorphism was amplified by polymerase chain reaction from blood genomic cells and digested with AluI restriction enzyme for distinction of G and A variants. Qualitative variables were compared using the chi-square and Fisher's exact tests and unpaired t-test for quantitative variables. After stratification of the groups, risk factors for POP were estimated using odds ratios (ORs) from the binary logistic regression model. A total of 292 women were included, 112 in the POP group and 180 in the control group. There was no significant difference between groups regarding rs1800255. Age and home birth were the only significant risk factors for pelvic organ prolapse. Polymorphism rs1800255 from COL3A1 gene was not a risk factor for pelvic organ prolapse.

Association between delivery mode and pelvic organ prolapse: A meta-analysis of observational studies

Pelvic organ prolapse (POP) is a common disease in aged women with negative physical and psychological influences. The long-term impact of delivery mode on POP remains uncertain. To evaluate the relationship between delivery mode and POP, a meta-analysis was carried out in this study. PubMed, Web of Science and CENTRAL were combined to search for relevant studies. Data were extracted by two investigators independently. Odd ratios (ORs) and 95% confidence intervals (95% CIs) were calculated by a random-effects model. Sensitivity analysis was performed to explore the potential source of heterogeneity. Moreover, Begg’s and Egger’s tests were conducted to assess the publication bias of included studies. In total, 13 eligible studies were included in our meta-analysis. Among them, six studies using objective standards for POP definition were included in Group 1, 5 studies addressing the women’s own perception of POP were included Group 2, and the remaining 2 studies with both objective and subjective measures for POP assessment were included in both group 1 and group 2. Pooled estimates in our study demonstrated increased risk of POP after any vaginal delivery vs. cesarean section (Group 1: OR = 7.69; 95% CI = 4.89, 12.07; heterogeneity: P = 0.00, I2 = 85.8%. Group 2: OR = 2.22; 95% CI = 1.72, 2.87; heterogeneity: P = 0.10, I2 = 43.5%). Similar results were found in the comparison of spontaneous vaginal births only vs. cesarean sections (Group 1: OR = 7.76; 95% CI = 4.43, 13.60; Group 2: OR = 2.08; 95% CI = 1.50, 2.89). There was no significant difference in POP between assisted vaginal delivery (including vacuum and forceps) and spontaneous vaginal births. Compared with cesarean sections, vaginal delivery (including women delivering only by spontaneous vaginal births and women with both vaginal and cesarean deliveries) is associated with an increased risk of long-term POP.

Pelvic Organ Prolapse Symptoms in American Samoan Women

American Samoa has one of the highest rates of obesity worldwide, making it a population at high risk for pelvic organ prolapse (POP). The primary objective of this study was to describe the presence of POP symptoms and associated degree of bother in American Samoan women. The secondary objective was to determine which characteristics are associated with POP symptoms in this cohort. We performed a cross-sectional survey of women presenting to the waiting room of the emergency department of the Lyndon B. Johnson Tropical Medical Center in Faga'alu, American Samoa from February to March 2017. Questions included self-described characteristics and the Pelvic Organ Prolapse Distress Inventory 6. Univariate distributions were described and comparisons of social and health characteristics were made between women without POP symptoms and those with at least 1 POP symptom. Two hundred eighty-four women were approached and 225 women completed the survey (79% response rate). The mean (SD) age was 40.5 (14.7), the mean (SD) body mass index was 36.4 (8.7), and the median (range) number of vaginal births was 2 (0-14). A total of 44.2% endorsed at least 1 POP symptom, most commonly pelvic pressure (29.9%) and feeling of incomplete bladder emptying (26.7%). The number of vaginal births was associated with lower abdominal pressure (P = 0.04) and hysterectomy was associated with pelvic heaviness (P = 0.05). This is the first study investigating POP in American Samoa. Almost half of women reported at least 1 pelvic floor symptom, demonstrating the need for further research on pelvic floor disorders within this high-risk population.

Does Home Birth Reduce the Risk of Pelvic Organ Prolapse?

To determine the relationship between vaginal birth and the development of POP among women who deliv-ered in non-hospital settings (home birth). Data were collected retrospectively from the files of patients who presented to a hospital outpatient clinic between April 1, 2011 and April 1, 2012 with complaints of urinary incontinence, uterine sagging, vaginal mass, or vaginal pain. The patients' age, height, weight, body mass index, menopause age, number of deliveries, and presence of hypertension and diabetes mellitus were noted. Patients whose urogynecologic evaluation included POP Quantification (POP-Q) scoring were included in the study. The patients were separated into a group of women who had never given birth and another group of women with one or more deliveries. Of the 179 patients in the study, 28 had never given birth and 151 had given birth at least once. The nulliparous patients had no cystocele, rectocele, or uterine prolapse. The prevalence rates of cystocele, rectocele, and uterine prolapse were significantly higher in the multiparous group. Cystocele, rectocele, and uterine prolapse development were significantly correlated with number of deliveries, but there was no statistical association with age, body mass index, menopausal age, diabetes mellitus, or hypertension. univariate analysis reveals that the only factor effective in the development of cytocele, rectocele and prolapse is the number of births. Our study suggests that only number of deliveries is associated with development of cystocele, rectocele, and uterine prolapse in women who gave birth by vaginal route in residential settings.

Pelvic organ prolapse and urogynecological assessment in women with spinal cord injury.

Observational cross-sectional study. Due to weakened pelvic floor muscles, the risk of pelvic organ prolapse (POP) may increase after a spinal cord injury (SCI); hence, the aim of this study was to investigate the occurrence of POP after SCI and to evaluate the need for urogynecological consultations offered to women with SCI. Clinic for Spinal Cord Injuries, Rigshospitalet, Denmark. Women with SCI who visited our SCI-clinic during January 2013-January 2018 were offered a specialized urogynecological consultation. Any symptoms of POP, urinary/fecal incontinence, or bladder/bowel emptying problems were registered, and POP was classified according to the POP quantification system during a pelvic examination. Differences in baseline characteristics between women with POP stage 0-1 and POP stage ≥2 were investigated. A total of 98 women were included in the study. Fourteen women (14%) reported POP symptoms and 21 women (21%) had anatomical POP stage ≥2. The group with POP stage ≥2 had a significantly higher age, higher parity, more with vaginal delivery, and more postmenopausal women, but the groups did not differ on median time after injury, neurological level, and completeness of injury. A total of 71% experienced urinary incontinence, 27% experienced fecal incontinence, 63% experienced bladder emptying problems, and 70% experienced bowel emptying problems. Consequently, 65% received treatment. Women with SCI are not in increased risk of developing anatomical POP. Nonetheless, the high occurrence of other urogynecological issues and the high treatment-rate supports the need for specialized urogynecological consultations offered to women with SCI.