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Keywords:

  • Caesarean delivery;
  • pelvic organ prolapse;
  • pelvic organ prolapse quantification;
  • pelvic organ support;
  • postpartum;
  • trial of labour

Objective

Compare changes in pelvic organ prolapse (POP) from 36–38 weeks of gestation to 1 year postpartum after unlaboured cesarean delivery(UCD)and trial of labour (TOL).

Design

Prospective observational cohort study.

Setting

Wenzhou Third People's Hospital, Wenzhou, Zhejiang, China.

Population

Nulliparous women undergoing UCD or TOL.

Methods

Pelvic organ prolapse was assessed at 36–38 weeks of gestation, then at 6 weeks, 6 months and 1 year postpartum, using the Pelvic Organ Prolapse Quantification (POPQ) system.

Main outcome measures

Postpartum POP status in UCD and TOL determined by POPQ measurements over time.

Results

Points 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 36–38 weeks 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 36–38 weeks 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.

Conclusion

Factors unique to labour and delivery lead to sustained pelvic floor relaxation postpartum. Pelvic organ prolapse at 36–38 weeks 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.