Intrapartum risk factors associated with pelvic organ prolapse at 6 months postpartum

Alexander M. Saucedo, Holly E. Richter, W. Thomas Gregory, Candice Woolfolk, Methodius G. Tuuli, Jerry L. Lowder, Aaron B. Caughey, Sindhu K. Srinivas, Alan T.N. Tita, George A. Macones, Alison G. Cahill

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: Pregnancy and childbirth are known risk factors associated with the development of pelvic organ prolapse; specific intrapartum risk factors are not well characterized. OBJECTIVE: This study aimed to determine intrapartum factors associated with increased risk of pelvic organ prolapse identified after delivery. STUDY DESIGN: A planned secondary analysis of a multicenter randomized clinical trial of delayed vs immediate pushing among nulliparous women at ≥37 weeks of gestation in labor with neuraxial analgesia was conducted at 6 academic and community hospitals in the United States. Intrapartum characteristics were identified, and Pelvic Organ Prolapse Quantification assessments at 6 weeks and 6 months after delivery were performed. The primary outcome was pelvic organ prolapse, defined as stage 2 or greater prolapse using the Pelvic Organ Prolapse Quantification assessment at 6 months. Multivariable logistic regression was used to refine risk estimates while adjusting for randomization group, macrosomia, and maternal age. RESULTS: Among the 941 women participating in the pelvic floor follow-up, 793 women had Pelvic Organ Prolapse Quantification assessments at 6 weeks with 91 of 793 women (11.5%) demonstrating stage 2 or greater prolapse. Of the 728 women followed up at 6 months, stage 2 or greater prolapse was identified in 58 of 728 women (8.0%). Prostaglandin use for induction of labor was associated with an increased risk at 6 months (adjusted odds ratio, 2.15; 95% confidence interval, 1.18–3.91; P<.01). The length and type (spontaneous vs induced) of the first stage of labor were not significantly associated with stage 2 or greater prolapse. Moreover, increased length of the second stage of labor and duration of pushing were not associated with stage 2 or greater prolapse. After adjusting for confounding factors, cesarean delivery was protective of pelvic organ prolapse at 6 months (adjusted odds ratio, 0.12; 95% confidence interval, 0.02–0.90). CONCLUSION: The management of the first and second stages of labor, including time length, was not associated with stage 2 or greater prolapse at 6 months. The findings that prostaglandin exposure was associated with increased risk likely were not directly affecting the risk of prolapse but may be surrogates for other labor features that deserve exploration. Cesarean delivery was associated with protection from stage 2 or greater pelvic organ prolapse at 6 months, consistent with previous literature.

Original languageEnglish (US)
Article number100692
JournalAmerican journal of obstetrics &amp; gynecology MFM
Volume4
Issue number6
DOIs
StatePublished - Nov 2022

Keywords

  • cesarean delivery
  • delayed pushing
  • immediate pushing
  • labor duration
  • pelvic organ prolapse
  • Pelvic Organ Prolapse Quantification
  • pregnancy
  • prolapse
  • prostaglandins

ASJC Scopus subject areas

  • Obstetrics and Gynecology

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