title: Status of the pelvic floor in young primiparous women.
abstract: OBJECTIVE
  To investigate the postnatal prevalence of sonographically diagnosed pelvic floor trauma, and the correlations with various antenatal/intrapartum predictors in primiparous women.
  
  
  METHODS
  This was a prospective cohort study performed in a tertiary hospital with 9000 deliveries per annum. Of those invited, 202 (23.2%) primiparous participants were assessed clinically at least 1 year after delivery by Pelvic Organ Prolapse Quantification (POP-Q), two/three-dimensional transperineal sonography and quantification of serum collagen type III levels.
  
  
  RESULTS
  There was a high prevalence of clinically significant pelvic organ prolapse (POP) on POP-Q staging: uterine prolapse, 63%; cystocele, 42%; and rectocele, 23%. Ballooning of the levator ani muscle (LAM) hiatus was detected in 33% and LAM avulsion in 29% of participants, with partial LAM avulsion occurring in 15% and complete avulsion in 14%. Postnatal POP symptoms (odds ratios (ORs) given here for presence of multiple prolapse symptoms) were positively associated with similar prepregnancy symptoms (OR, 7.2 (95% CI, 1.19-44.33)), LAM avulsion (OR, 4.8 (95% CI, 1.99-11.34)) and forceps delivery (borderline significance; OR, 1.8 (95% CI, 0.96-3.25)) and negatively associated with elective (OR, 0.2 (95% CI, 0.09-0.63)) and emergency (OR, 0.3 (95% CI, 0.12-0.83)) Cesarean section. LAM abnormality was associated with forceps delivery (OR, 4.9 (95% CI, 1.44-16.97)) and prolapse (OR, 6.8-11.7 (95% CI, 2.34-78.51)), whereas collagen levels did not play a role (OR, 1.001 (95% CI, 0.99-1.02)).
  
  
  CONCLUSIONS
  Clinically significant POP was common in relatively young premenopausal primiparous women. Partial or full levator avulsion was seen in 29% of participants and was associated with POP and related symptoms. Congenital factors seem to play little role in the etiology of LAM trauma, and the main risk factor seems to be forceps delivery. Avoidance of difficult vaginal deliveries may prevent severe pelvic floor trauma.
authors.affiliation: The Irish Centre for Fetal and Neonatal Translational Research (INFANT) and Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland.|Department of Urogynaecology, Cork University Maternity Hospital (CUMH), Cork, Ireland.
authors.forename: C M
authors.initials: CM
authors.lastname: Durnea
authors.affiliation: The Irish Centre for Fetal and Neonatal Translational Research (INFANT) and Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland.|Department of Urogynaecology, Cork University Maternity Hospital (CUMH), Cork, Ireland.
authors.forename: B A
authors.initials: BA
authors.lastname: O'Reilly
authors.affiliation: The Irish Centre for Fetal and Neonatal Translational Research (INFANT) and Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland.|Department of Epidemiology and Public Health, University College Cork, Cork, Ireland.
authors.forename: A S
authors.initials: AS
authors.lastname: Khashan
authors.affiliation: The Irish Centre for Fetal and Neonatal Translational Research (INFANT) and Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland.
authors.forename: L C
authors.initials: LC
authors.lastname: Kenny
authors.affiliation: The Irish Centre for Fetal and Neonatal Translational Research (INFANT) and Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland.
authors.forename: U A
authors.initials: UA
authors.lastname: Durnea
authors.affiliation: School of Medicine, University College Cork, Cork, Ireland.
authors.forename: M M
authors.initials: MM
authors.lastname: Smyth
authors.affiliation: Sydney Medical School Nepean, Nepean Hospital, Penrith, Australia.
authors.forename: H P
authors.initials: HP
authors.lastname: Dietz
mesh_terms: D000293:Adolescent; D000328:Adult; D036861:Delivery, Obstetric / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007494:Ireland / Q000453:epidemiology; D016015:Logistic Models; D008875:Middle Aged; D010298:Parity; D017773:Pelvic Floor / Q000000981:diagnostic imaging / Q000293:injuries*; D056887:Pelvic Organ Prolapse / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology; D011247:Pregnancy; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D014463:Ultrasonography; D055815:Young Adult
keywords: 3D transperineal scan; LAM avulsion; POP; pelvic organ prolapse; primiparous