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oai:cora.ucc.ie:10468/17902023-04-04T07:09:34Zcom_10468_386com_10468_4com_10468_1com_10468_477col_10468_387col_10468_140col_10468_1777

Not applicable No embargo required Not applicable No embargo required No Embargo Required Khashan, Ali O'Reilly, Barry A. Kenny, Louise C. Durnea, Constantin M. Health Research Board Science Foundation Ireland Continence Foundation Ireland 2015-05-05T14:20:27Z 2015-05-05T14:20:27Z 2014 2015 Background: 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. Health Research Board (SCOPE HRBI CSA 2007/2); Not peer reviewed Accepted Version application/pdf Durnea, C. 2014. The impact of first pregnancy and delivery on pelvic floor dysfunction. PhD Thesis, University College Cork. 220 https://hdl.handle.net/10468/1790 en University College Cork © 2014, Constantin Durnea. http://creativecommons.org/licenses/by-nc-nd/3.0/ Pelvic floor dysfunction POP POP-Q ELISA test Collagen LAM LAM trauma RF Urinary incontinence Urinary urgency Urinary frequency Coital incontinence Faecal incontinence Faecal urgency Obstructed micturition Obstructed defaecation Bother Impact on social life Pelvic organ prolpase Cystocele Rectocele Uterine prolapse Transperineal 3D scan Joint hypermobility Family history collagen disorders Collagen disease Dyspareunia Vaginal laxity Vaginismus Sexual satisfaction Levator ani muscle trauma Pre-pregnancy Post-natal Nulliparous Nulliparas Primipara Primiparous Primip Risk factors Mode of delivery Caesarean section Forceps delivery Instrumental delivery Pre-pregnancy symptoms false The impact of first pregnancy and delivery on pelvic floor dysfunction Doctoral thesis Doctoral Degree (Structured) PhD (Medicine and Health) barry.oreilly@hse.ieinfo:eu-repo/semantics/openAccess