Childbearing is known as a major aetiological factor for Pelvic
Floor Dysfunction (PFD). This study aimed to look at risk factors associated with PFD, and delineate the group of patients
who might be at higher risk of having these complications.
This is a prospective cohort of well phenotyped, low-risk nulliparous women with singleton pregnancy embedded within
the Screening for Pregnancy Endpoints (SCOPE) cohort.
The validated Australian PFD questionnaire was completed by 870 primiparous women when recruited at 15 weeks’
gestation, with a particular focus on pre-pregnancy symptoms,
and 1 year postnatally. Detailed information about labour and delivery was collected shortly after delivery. Multivariate
logistic regression was used to examine the association of various risk factors with PFD.
We detected a high prepregnancy prevalence of PFD (urinary:
urgency (40.6 %), urge incontinence(12.2 %), stress
incontinence (18.7 %); faecal: urgency (47.9 %), incomplete evacuation (42.6 %); prolapse: vaginal pressure (3.3 %);
sexual: dyspareunia (32.1 %), poor vaginal sensation (12,5 %),
vaginal laxity (4.9 %)).
Prenatal symptoms showed high postnatal persistence: urinary– 88 %, faecal-93 %, prolapse-39 %, sexual-79 %. The Prepregnancy affected group with Persistent PFD postnatally
(PPPFD) was dominant among all postnatally affected participants:
urinary-77 %, faecal-92 %, prolapse-13 %, sexual- 62 %. PPPFD group had a higher median symptom score compared to De Novo Onset (DNO) postnatal PFD
(DNOPFD) group: bladder-3vs.1; bowel-4vs.2; and sex- 2vs.1. Similarly, the bothersome from symptoms was higher
in the PPPFD group. Interestingly, in contrast to stress urinary incontinence (SUI), symptoms of overactive bladder (OAB) were more prevalent in PPFD comparing to DNO group; SUI- 29,7 % vs.15,4 %, OAB-12.3 % vs. 11.1 %. Prepregnancy PPPFD score had worsened postnatally in nearly half of participants: urinary-48 %; faecal-41 %;, sexual-45 %.
Main risk factors associated with postnatal PFD were (Odds Ratio [Confidence Interval]): presence of prenatal symptoms
−5.08 [3.3–7.9], young maternal age 2.43 [1.3–4.4], use of
oxytocin in labour 2.26 [1.1–4.6], induction of labour 1.57 [1.3–2.2]. Risk of PFD was reduced by Caesarean Section (CS) 0.48 [0.1–0.6]. Women with higher PFD scores
postnatally had more instrumental deliveries (50 % vs.23 %)
and longer second stage of labour (82′vs.54′), whereas those
with low PFD scores had more spontaneous deliveries
(49%vs.31 %) and CS (27 % vs.19 %).
This is the first time, when such a high rate of pre-pregnancy PFD was demonstrated in nulliparous women followed
by high postnatal persistence. Among all postnatally
symptomatic, PPPFD predominated and their PFD scores were higher than in DNOPFD group. Prepregnancy
OAB symptoms seem to worsen more postnatally comparing to SUI. Prepregnancy PFD is the major risk factor associated with postnatal PFD, while
Caesarean Section had a protective role.