The recovery of pelvic organ support during the first year postpartum

ObjectiveCompare changes in pelvic organ prolapse (POP) from 36-38weeks of gestation to 1year postpartum after unlaboured cesarean delivery(UCD)and trial of labour (TOL). DesignProspective observational cohort study. SettingWenzhou Third People's Hospital, Wenzhou, Zhejiang, China. PopulationNulliparous women undergoing UCD or TOL. MethodsPelvic organ prolapse was assessed at 36-38weeks of gestation, then at 6weeks, 6months and 1year postpartum, using the Pelvic Organ Prolapse Quantification (POPQ) system. Main outcome measuresPostpartum POP status in UCD and TOL determined by POPQ measurements over time. ResultsPoints Aa (Ba) determined the final stage assignment in most cases. Stage II POP was present in 35% and 37% of women in UCD and TOL at 36-38weeks of gestation. After delivery, the likelihood of stage II POP declined during the first year postpartum in the whole cohort. The TOL group was much less likely to recover from stage II POP compared with the UCD group (odds ratio 0.04, 95% confidence interval 0.01-0.18) after adjustment for POP status at 36-38weeks of gestation, age, first-trimester body mass index, newborn birthweight, educational level, gravidity and smoking status. With the exception of age, education and gravidity, these covariates were also independent predictors of postpartum POP. ConclusionFactors unique to labour and delivery lead to sustained pelvic floor relaxation postpartum. Pelvic organ prolapse at 36-38weeks of gestation, and higher first-trimester body mass index also appear to predict long-term POP. Further investigation into mechanisms leading to persistent or progressive POP after TOL are warranted. In addition, caution is needed in generalising the findings due to the single-centre design.