title: The role of prepregnancy pelvic floor dysfunction in postnatal pelvic morbidity in primiparous women.
abstract: OBJECTIVE
  Little is known about the natural history of pelvic floor dysfunction (PFD). We investigated the association between prepregnancy and postnatal PFD in premenopausal primiparous women and the associated effect of mode of delivery.
  
  
  METHODS
  A prospective cohort study, nested within the parent Screening for Pregnancy Endpoints (SCOPE) study, was performed in a tertiary referral teaching hospital with approximately 9,000 deliveries per annum. The validated Australian pelvic floor questionnaire was completed by 872 nulliparous women at 15 weeks' gestation, at the time of recruitment to the SCOPE study and 1 year postnatally. The questionnaire contained four sections with questions about urinary, faecal, prolapse and sexual dysfunction.
  
  
  RESULTS
  One year postnatally urinary dysfunction was present in 73%, faecal in 49%, prolapse in 14% and sexual in 58% of participants. Prepregnancy PFD persistent postnatally constituted more than half of total PFD. The majority of affected (71%) had multicompartment involvement. Participants with persistent PFD had higher prevalence of severe symptoms and bothersome symptoms within the group. Severity of prepregnancy PFD worsened in <15% cases postnatally.
  
  
  CONCLUSIONS
  The main damage to the pelvic floor seems to occur in the majority of patients before first pregnancy, where first childbearing does not worsen prepregnancy PFD in the majority of cases. Pregnancy appears to affect more pre-existing symptoms of urgency and urge incontinence comparing to stress incontinence. Caesarean section seems to be more protective against postnatal worsening of prepregnancy PFD comparing to de novo onset pathology. However, larger studies are needed to confirm these findings.
authors.affiliation: The Irish Centre for Fetal and Neonatal Translational Research (INFANT) and Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland, costea.durnea@gmail.com.
authors.forename: C M
authors.initials: CM
authors.lastname: Durnea
authors.forename: A S
authors.initials: AS
authors.lastname: Khashan
authors.forename: L C
authors.initials: LC
authors.lastname: Kenny
authors.forename: S S
authors.initials: SS
authors.lastname: Tabirca
authors.forename: B A
authors.initials: BA
authors.lastname: O'Reilly
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D036861:Delivery, Obstetric; D005242:Fecal Incontinence / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D010298:Parity; D017773:Pelvic Floor / Q000503:physiopathology*; D056887:Pelvic Organ Prolapse / Q000453:epidemiology*; D011247:Pregnancy; D015995:Prevalence; D011644:Puerperal Disorders / Q000453:epidemiology*; D012307:Risk Factors; D012735:Sexual Dysfunction, Physiological / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D014549:Urinary Incontinence / Q000453:epidemiology*; D055815:Young Adult
references.citation: Int J Colorectal Dis. 2009 Oct;24(10):1227-32
references.pmid: 19495778
references.citation: Br J Obstet Gynaecol. 1980 Oct;87(10):897-900
references.pmid: 7426487
references.citation: Obstet Gynecol. 2006 Oct;108(4):863-72
references.pmid: 17012447
references.citation: BJOG. 2000 Dec;107(12):1460-70
references.pmid: 11192101
references.citation: J Urol. 2006 Jan;175(1):259-64
references.pmid: 16406923
references.citation: BJOG. 2012 Oct;119(11):1361-9
references.pmid: 22827735
references.citation: Int Urogynecol J. 2014 Mar;25(3):337-45
references.pmid: 24072395
references.citation: JAMA. 2008 Sep 17;300(11):1311-6
references.pmid: 18799443
references.citation: Acta Obstet Gynecol Scand. 2012 Aug;91(8):901-10
references.pmid: 22497363
references.citation: J Clin Epidemiol. 2000 Nov;53(11):1150-7
references.pmid: 11106889
references.citation: Int Urogynecol J. 2013 Sep;24(9):1473-9
references.pmid: 23229419
references.citation: Am J Obstet Gynecol. 2002 Jun;186(6):1160-6
references.pmid: 12066091
references.citation: N Engl J Med. 2003 Mar 6;348(10):900-7
references.pmid: 12621134
references.citation: Am J Epidemiol. 2004 Apr 1;159(7):702-6
references.pmid: 15033648
references.citation: Int Urogynecol J Pelvic Floor Dysfunct. 2009 Feb;20(2):149-58
references.pmid: 18958382
references.citation: Aust N Z J Obstet Gynaecol. 2005 Oct;45(5):391-4
references.pmid: 16171474
references.citation: Am J Obstet Gynecol. 2003 Nov;189(5):1268-74
references.pmid: 14634552
references.citation: Birth. 1993 Sep;20(3):136-41
references.pmid: 8240621
references.citation: Int Urogynecol J. 2010 Feb;21(2):193-202
references.pmid: 19834637
references.citation: Nurs Res. 1994 Sep-Oct;43(5):301-6
references.pmid: 7937177