Conference Contribution Details
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Durnea CM, Kenny LC, Khashan AS, O'Reilly BA
The Annual Research Meeting of the British Society of Urogynaecology 2013.
How important is pre-pregnancy pelvic floor dysfunction in postnatal morbidity in primiparous women?
RCOG, London, UK
Invited Oral Presentation
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Introduction 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. Methods 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. Results 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 %). Conclusions 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.