title: Association between pelvic floor muscle trauma and pelvic organ prolapse 20 years after delivery.
abstract: OBJECTIVE
  It is known that pelvic floor muscle trauma (PFMT) after vaginal delivery is associated with pelvic organ prolapse (POP) symptoms (sPOP) and signs (POP-Q ≥2) in patient populations. Our aims were to establish the prevalence and investigate a possible association between PFMT and sPOP and POP-Q ≥2 in healthy women 20 years after their first delivery.
  
  
  METHODS
  During 2013 and 2014 we conducted a cross-sectional study among 847 women who delivered their first child between 1990 and 1997. Women responded to a postal questionnaire and were offered a clinical examination including prolapse grading and pelvic floor ultrasonography. The main outcome measures were sPOP, POP-Q ≥2 and PFMT, defined by levator avulsion or a levator hiatal area on Valsalva manoeuvre of >40 cm(2) on ultrasonography.
  
  
  RESULTS
  Of the 847 eligible women, 608 (72 %) were examined. Data on POP symptoms, POP-Q stage, levator avulsion and levator hiatal area were available in 598, 608, 606 and 554 women, respectively, and of these 75 (13%) had sPOP, 275 (45%) had POP-Q ≥2, 113 (19 %) had levator avulsion and 164 (30%) had a levator hiatal area >40 cm(2). Levator avulsion was associated with POP-Q ≥2 with an odds ratio (OR) of 9.91 and a 95% confidence interval (CI) of 5.73 - 17.13, and with sPOP (OR 2.28, 95% CI 1.34 - 3.91). Levator hiatal area >40 cm(2) was associated with POP-Q ≥2 (OR 6.98, 95% CI 4.54, - 10.74) and sPOP (OR 3.28, 95 % CI 1.96 - 5.50).
  
  
  CONCLUSIONS
  Many healthy women selected from the general population have symptoms and signs of POP 20 years after their first delivery, and PFMT is associated with POP-Q ≥2 and sPOP.
authors.affiliation: Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, P.O. Box 8905, Medisinsk teknisk forskningssenter, 7491, Trondheim, Norway. ingrid.volloyhaug@ntnu.no.|Department of Obstetrics and Gynecology, Trondheim University Hospital, Trondheim, Norway. ingrid.volloyhaug@ntnu.no.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Volløyhaug
authors.affiliation: Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway.|Clinical Service, Trondheim University Hospital, Trondheim, Norway.
authors.forename: Siv
authors.initials: S
authors.lastname: Mørkved
authors.affiliation: Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, P.O. Box 8905, Medisinsk teknisk forskningssenter, 7491, Trondheim, Norway.|National Center for Fetal Medicine, Trondheim University Hospital, Trondheim, Norway.
authors.forename: Kjell Å
authors.initials: KÅ
authors.lastname: Salvesen
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric; D005260:Female; D006801:Humans; D008875:Middle Aged; D017773:Pelvic Floor / Q000293:injuries*; D056887:Pelvic Organ Prolapse / Q000453:epidemiology* / Q000209:etiology*; D015995:Prevalence; D013997:Time Factors
keywords: Levator avulsion; Levator hiatus area; Pelvic floor muscle trauma; Pelvic organ prolapse