title: Childbirth and prolapse: long-term associations with the symptoms and objective measurement of pelvic organ prolapse.
abstract: OBJECTIVE
  To investigate prolapse symptoms and objectively measured pelvic organ prolapse, 12 years after childbirth, and association with delivery mode history.
  
  
  METHODS
  Twelve-year longitudinal study.
  
  
  METHODS
  Maternity units in Aberdeen, Birmingham and Dunedin.
  
  
  METHODS
  Women dwelling in the community.
  
  
  METHODS
  Data from women were collected 12 years after an index birth and women were invited for examination. Logistic regression investigated associations between risk factors and prolapse symptoms and signs.
  
  
  METHODS
  Prolapse symptom score (POP-SS); objectively measured prolapse (POP-Q).
  
  
  RESULTS
  Of 7725 continuing women, 3763 (49%) returned questionnaires at 12 years. The median POP-SS score was 2 (IQR 0-4). One or more forceps deliveries (OR 1.20, 95% CI 1.04-1.38) and a body mass index (BMI) over 25 were associated with higher (worse) POP-SS scores, but age over 25 years at first delivery was associated with lower (better) scores. There was no protective effect if all deliveries were by caesarean section (OR 0.84, 95% CI 0.69-1.02). Objective prolapse was found in 182/762 (24%) women. Women aged over 30 years when having their first baby and parity were significantly associated with prolapse. Compared with women whose births were all spontaneous vaginal deliveries, women who had all births by caesarean section were the least likely to have prolapse (OR 0.11, 95% CI 0.03-0.38), and there was a reduced risk after forceps or a mixture of spontaneous vaginal delivery and caesarean section.
  
  
  CONCLUSIONS
  These findings are at odds with each other, suggesting that prolapse symptoms and objective prolapse may not be in concordance, or are associated with different antecedent factors. Further follow-up is planned.
authors.affiliation: Health Services Research Unit, University of Aberdeen, Aberdeen, UK.
authors.forename: C
authors.initials: C
authors.lastname: Glazener
authors.affiliation: Health Services Research Unit, University of Aberdeen, Aberdeen, UK.
authors.forename: A
authors.initials: A
authors.lastname: Elders
authors.affiliation: Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, Birmingham, UK.
authors.forename: C
authors.initials: C
authors.lastname: MacArthur
authors.affiliation: Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, Birmingham, UK.
authors.forename: R J
authors.initials: RJ
authors.lastname: Lancashire
authors.affiliation: Departments of Women's and Children's Health and Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
authors.forename: P
authors.initials: P
authors.lastname: Herbison
authors.affiliation: NMAHP Research Unit, Glasgow Caledonian University, Glasgow, UK.
authors.forename: S
authors.initials: S
authors.lastname: Hagen
authors.affiliation: Department of Obstetrics and Gynaecology, York Hospital, York, UK.
authors.forename: N
authors.initials: N
authors.lastname: Dean
authors.affiliation: Department of Obstetrics and Gynaecology, Aberdeen Royal Infirmary, Aberdeen, UK.
authors.forename: C
authors.initials: C
authors.lastname: Bain
authors.affiliation: Birmingham Women's Hospital, Birmingham Women's NHS Foundation Trust, Edgbaston, Birmingham, UK.
authors.forename: P
authors.initials: P
authors.lastname: Toozs-Hobson
authors.affiliation: Department of Obstetrics and Gynaecology, Aberdeen Royal Infirmary, Aberdeen, UK.
authors.forename: K
authors.initials: K
authors.lastname: Richardson
authors.affiliation: Health Services Research Unit, University of Aberdeen, Aberdeen, UK.
authors.forename: A
authors.initials: A
authors.lastname: McDonald
authors.affiliation: Health Services Research Unit, University of Aberdeen, Aberdeen, UK.
authors.forename: G
authors.initials: G
authors.lastname: McPherson
authors.affiliation: Departments of Women's and Children's Health and Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
authors.forename: D
authors.initials: D
authors.lastname: Wilson
mesh_terms: D000328:Adult; D002585:Cesarean Section; D036861:Delivery, Obstetric / Q000009:adverse effects / Q000379:methods; D005113:Extraction, Obstetrical / Q000009:adverse effects; D005260:Female; D006306:Health Surveys; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D036801:Parturition; D056887:Pelvic Organ Prolapse / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D011247:Pregnancy; D012307:Risk Factors; D011795:Surveys and Questionnaires; D006113:United Kingdom / Q000453:epidemiology