The impact of first pregnancy and delivery on pelvic floor dysfunction

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dc.check.embargoformatNot applicableen
dc.check.infoNo embargo requireden
dc.check.opt-outNot applicableen
dc.check.reasonNo embargo requireden
dc.check.typeNo Embargo Required
dc.contributor.advisorKhashan, Alien
dc.contributor.advisorO'Reilly, Barry A.en
dc.contributor.advisorKenny, Louise C.en
dc.contributor.authorDurnea, Constantin M.
dc.contributor.funderHealth Research Boarden
dc.contributor.funderScience Foundation Irelanden
dc.contributor.funderContinence Foundation Irelanden
dc.date.accessioned2015-05-05T14:20:27Z
dc.date.available2015-05-05T14:20:27Z
dc.date.issued2014
dc.date.submitted2015
dc.description.abstractBackground: The first childbirth has the greatest impact on a woman’s pelvic floor when major changes occur. The aim of this study was to comprehensively describe pelvic floor dysfunction (PFD) in young nulliparous women, and its correlation with postnatal pathology. Methods: A prospective study was performed at Cork University Maternity Hospital, Ireland. Initially 1484 nulliparous women completed the validated Australian Pelvic Floor Questionnaire at 15 weeks’ gestation and repeatedly at one year postnatally (N=872). In the second phase, at least one year postnatally, 202 participants without subsequent pregnancies attended the clinical follow up which included: pelvic organ prolapse quantification, a 3D-Transperineal ultrasound scan and collagen level assessment. Results: A high pre-pregnancy prevalence of various types of PFD was detected, which in the majority of cases persisted postnatally and included multiple types of PFD. The first birth had a negative impact on severity of pre-pregnancy symptoms in <15% of cases. Apart from prolapse, vaginal delivery, including instrumental delivery did not increase the risk of PFD symptoms, where as Caesarean section was protective for all types of PFD. The first birth had a bigger impact on pre-existing symptoms of overactive bladder compared to stress urinary incontinence. Pelvic organ prolapse is extremely prevalent in young primiparous women, however usually it is low grade and asymptomatic. Congenital factors and high collagen type III levels play an important role in the aetiology of pelvic organs prolapse. Levator ani trauma is present in one in three women after the first pregnancy and delivery. Conclusion: The main damage to the pelvic floor most likely occurs due to an undiagnosed congenital intrinsic weakness of the pelvic floor structures. PFD is highly associated with first childbirth, however it seems that pregnancy and delivery are contributing factors only which unmask the congenital intrinsic weakness of the pelvic floor support.en
dc.description.sponsorshipHealth Research Board (SCOPE HRBI CSA 2007/2);en
dc.description.statusNot peer revieweden
dc.description.versionAccepted Version
dc.format.mimetypeapplication/pdfen
dc.identifier.citationDurnea, C. 2014. The impact of first pregnancy and delivery on pelvic floor dysfunction. PhD Thesis, University College Cork.en
dc.identifier.endpage220
dc.identifier.urihttps://hdl.handle.net/10468/1790
dc.language.isoenen
dc.publisherUniversity College Corken
dc.rights© 2014, Constantin Durnea.en
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/3.0/en
dc.subjectPelvic floor dysfunctionen
dc.subjectPOPen
dc.subjectPOP-Qen
dc.subjectELISA testen
dc.subjectCollagenen
dc.subjectLAMen
dc.subjectLAM traumaen
dc.subjectRFen
dc.subjectUrinary incontinenceen
dc.subjectUrinary urgencyen
dc.subjectUrinary frequencyen
dc.subjectCoital incontinenceen
dc.subjectFaecal incontinenceen
dc.subjectFaecal urgencyen
dc.subjectObstructed micturitionen
dc.subjectObstructed defaecationen
dc.subjectBotheren
dc.subjectImpact on social lifeen
dc.subjectPelvic organ prolpaseen
dc.subjectCystoceleen
dc.subjectRectoceleen
dc.subjectUterine prolapseen
dc.subjectTransperineal 3D scanen
dc.subjectJoint hypermobilityen
dc.subjectFamily history collagen disordersen
dc.subjectCollagen diseaseen
dc.subjectDyspareuniaen
dc.subjectVaginal laxityen
dc.subjectVaginismusen
dc.subjectSexual satisfactionen
dc.subjectLevator ani muscle traumaen
dc.subjectPre-pregnancyen
dc.subjectPost-natalen
dc.subjectNulliparousen
dc.subjectNulliparasen
dc.subjectPrimiparaen
dc.subjectPrimiparousen
dc.subjectPrimipen
dc.subjectRisk factorsen
dc.subjectMode of deliveryen
dc.subjectCaesarean sectionen
dc.subjectForceps deliveryen
dc.subjectInstrumental deliveryen
dc.subjectPre-pregnancy symptomsen
dc.thesis.opt-outfalse
dc.titleThe impact of first pregnancy and delivery on pelvic floor dysfunctionen
dc.typeDoctoral thesisen
dc.type.qualificationlevelDoctoral Degree (Structured)en
dc.type.qualificationnamePhD (Medicine and Health)en
ucc.workflow.supervisorbarry.oreilly@hse.ie
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