Examination of predisposing risk factors among primiparous women at risk of developing pelvic organ prolapse within a year of childbirth
Pelvic organ prolapse (POP) is a benign gynaecological condition with a multifactorial aetiology that affects 40–50% of adult women. However, the majority of studies focus on middle-aged and older individuals, and only a few have specifically investigated the natural history of POP during and following first pregnancies and deliveries. The dearth of research involving nulliparous women compounds the difficulty associated with the early identification of those at risk of developing POP before the manifestation of its symptoms. In line with the shift from treatment to prevention, the aim of this review is to identify and describe the predisposing and precipitating risk factors associated with developing POP in primiparous women within a year of childbirth in order to recommend early clinical objective assessment. A literature search using the CINAHL and MEDLINE databases was performed, and studies of the natural history of pelvic organ support during pregnancy and up to 1 year postpartum were identified. The papers selected objectively assessed POP using the Pelvic Organ Prolapse Quantification System, and one also included dynamic ultrasound imaging. Six observational cohort studies involving primiparous women were critically appraised in order to identify predisposing risk factors for the condition. This review found that maternal pre-pregnancy pelvic floor anatomical differences, pregnancy and vaginal delivery are associated with the development of POP in first-time mothers. The studies also showed that Caesarean section delivery (CSD) after the onset of active labour does not offer complete protection against the development of POP. Elective CSD offered initial protection for the pelvic organ support structures. No strong association was found between POP, and levator ani muscle injury, race, body mass index, infant birth weight or maternal age at first delivery. The introduction of routine objective assessment of pelvic organ support during pregnancy and up to 1 year postpartum may improve rates of early identification of women who are susceptible to developing POP in later life.
Keywords: childbirth, pelvic organ prolapse, postpartum, primiparous, risk factors.