Change in pelvic organ support during pregnancy and the first year postpartum: a longitudinal study

ObjectiveTo describe changes in pelvic organ support from mid pregnancy until 1year postpartum among nulliparous pregnant women, and to examine whether delivery route affects changes in pelvic organ support. DesignProspective cohort study. SettingAkershus University Hospital in Norway. PopulationA cohort of 300 nulliparous pregnant women included at mid-pregnancy. MethodsPelvic organ support assessed at 21 and 37weeks of gestation, and again at 6weeks, 6months, and 12months postpartum, by the use of the Pelvic Organ Prolapse Quantification (POP-Q) system. Linear mixed model was used to assess longitudinal change in pelvic organ support. Main outcome measuresPrevalence of anatomic POP. Change in POP-Q variables over time and between delivery groups. ResultsThe prevalence of anatomic POP ranged from 0 to 10%. Vaginal POP-Q points made a cranial shift from mid to late pregnancy, a caudal shift following delivery, and again a cranial shift after 6weeks postpartum. Postpartum change was present following both vaginal and caesarean deliveries, but was more pronounced following vaginal delivery. The perineal body and genital hiatus became longer from mid to late pregnancy, and shortened after 6weeks postpartum. At 12months postpartum all POP-Q points, except cervix, had recovered to baseline in the vaginal delivery group. ConclusionsThe prevalence of anatomic POP was low in this cohort. There was change in pelvic organ support both during pregnancy and following vaginal as well as caesarean delivery. The short-term ability to recover was good after the first pregnancy and delivery.