What is to blame for postnatal pelvic floor dysfunction in primiparous women — Pre-pregnancy or intrapartum risk factors?

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dc.contributor.author Durnea, Constantin M.
dc.contributor.author Khashan, Ali S.
dc.contributor.author Kenny, Louise C.
dc.contributor.author Durnea, Uliana A.
dc.contributor.author Dornan, James C.
dc.contributor.author O'Sullivan, Suzanne M.
dc.contributor.author O'Reilly, Barry A.
dc.date.accessioned 2017-06-08T15:34:33Z
dc.date.available 2017-06-08T15:34:33Z
dc.date.issued 2017-04-23
dc.identifier.citation Durnea, C. M., Khashan, A. S., Kenny, L. C., Durnea, U. A., Dornan, J. C., O’Sullivan, S. M. and O’Reilly, B. A. (2017) 'What is to blame for postnatal pelvic floor dysfunction in primiparous women—Pre-pregnancy or intrapartum risk factors?', European Journal of Obstetrics & Gynecology and Reproductive Biology, 214, pp. 36-43. doi:10.1016/j.ejogrb.2017.04.036 en
dc.identifier.volume 214 en
dc.identifier.startpage 36 en
dc.identifier.endpage 43 en
dc.identifier.issn 0301-2115
dc.identifier.uri http://hdl.handle.net/10468/4067
dc.identifier.doi 10.1016/j.ejogrb.2017.04.036
dc.description.abstract Background: The aetiology of pelvic floor dysfunction (PFD) is still poorly understood. However childbearing is recognized as a major risk factor. Objectives: To elucidate the natural history of PFD by investigating the impact of the mode of delivery on postnatal pelvic floor dysfunction in primiparas, when PFD existing before the first pregnancy is taken into consideration. Study design: 4P-study (Prevalence and Predictors of Pelvic floor dysfunction in Primips) is a prospective cohort study, nested within the Screening for Pregnancy Endpoints (SCOPE) study set in a tertiary referral teaching hospital with 9000 deliveries annually. Established and proposed risk factors for urinary, fecal, prolapse and sexual dysfunction and the severity of symptoms for each of these outcomes were assessed using the Australian Pelvic Floor Questionnaire in 1482 nulliparous women, who each completed the questionnaire in early pregnancy. Of these, 1060 (72%) repeated the questionnaire 12 months postpartum. Outcomes were analyzed using multivariate ordinal logistic regression. Results: Significant (p < 0.05) risk factors for postpartum PFD were pre-pregnancy presence of similar symptoms Odds Ratio (OR) (5.0–30.0), smoking (OR 2.2–4.6), recurrent UTI (OR 2.2–17.3), high hip circumference (OR1.4–1.6), vigorous exercising (OR 3.1–17.9), induction of labor (OR 1.5–2.3), forceps delivery (OR 1.8–8.8), and 3rd degree perineal tear (OR 2.4–2.7). Cesarean section was associated with a lower risk of stress urinary incontinence (OR 0.3–0.5). Other common pre-pregnancy significant (p < 0.05) risk factors for various PFD types prior to the first pregnancy were: diagnosed depression – (OR 1.6–2.1), high BMI (OR 3.1), strenuous exercising (OR 1.3–2.2), recurrent UTI (OR 1.5–2.5) and lower educational achievement (OR 1.5–1.6). Conclusions: Pre-pregnancy PFD was mainly associated with modifiable risk factors such as smoking and exercising. The main risk factor for postpartum PFD was the presence of similar symptoms prior to pregnancy, followed by anthropometric and intrapartum factors. Hip circumference seems to be a better predictor of PFD compared to BMI. When pre-pregnancy PFD was included in the analysis, Cesarean section was protective only for stress urinary incontinence, while delivery by forceps increased the risk of prolapse. en
dc.description.sponsorship Health Research Board of Ireland (SCOPE Ireland, Grant Reference CSA 2007/2); Continence Foundation Ireland; Science Foundation Ireland (SFI Program Grant for INFANT (12/RC/2272)) en
dc.format.mimetype application/pdf en
dc.language.iso en en
dc.publisher Elsevier en
dc.rights © 2017 Elsevier B.V. This manuscript version is made available under the CC-BY-NC-ND 4.0 license en
dc.rights.uri http://creativecommons.org/licenses/by-nc-nd/4.0/ en
dc.subject Pelvic floor dysfunction en
dc.subject Primiparous en
dc.subject Pre-pregnancy en
dc.subject Postpartum en
dc.subject Childbirth en
dc.subject Risk factors en
dc.title What is to blame for postnatal pelvic floor dysfunction in primiparous women — Pre-pregnancy or intrapartum risk factors? en
dc.type Article (peer-reviewed) en
dc.internal.authorcontactother Ali Khashan, Epidemiology & Public Health, University College Cork, Cork, Ireland. +353-21-490-3000 Email: a.khashan@ucc.ie en
dc.internal.availability Full text available en
dc.check.info Access to this article is restricted until 12 months after publication at the request of the publisher. en
dc.check.date 2018-04-23
dc.date.updated 2017-06-08T14:52:31Z
dc.description.version Accepted Version en
dc.internal.rssid 398178513
dc.contributor.funder Health Research Board en
dc.contributor.funder Science Foundation Ireland en
dc.description.status Peer reviewed en
dc.identifier.journaltitle European Journal of Obstetrics & Gynecology and Reproductive Biology en
dc.internal.copyrightchecked No !!CORA!! en
dc.internal.licenseacceptance Yes en
dc.internal.IRISemailaddress a.khashan@ucc.ie en


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© 2017 Elsevier B.V. This manuscript version is made available under the CC-BY-NC-ND 4.0 license Except where otherwise noted, this item's license is described as © 2017 Elsevier B.V. This manuscript version is made available under the CC-BY-NC-ND 4.0 license
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