Correlation Between Delivery Mode and Pelvic Organ Prolapse Evaluated by Four-Dimensional Pelvic Floor Ultrasonography

Abstract

BACKGROUND This study explored symptoms and signs of pelvic organ prolapse (POP) evaluated by 4-dimensional pelvic floor ultrasonography and analyzed the relationship between delivery mode and POP. MATERIAL AND METHODS A total of 578 women who underwent 4-dimensional transperineal ultrasound were enrolled in this study. Obstetric history together with other clinical information were gathered from clinical questionnaires and gynecologists. Patients were thereafter classified into 4 groups: women with normal vaginal delivery, women with forceps delivery, women with cesarean, and nullipara women. We assessed symptoms and signs of POP among these 4 groups by use of 2 evaluation methods. The first method was clinical assessment applying International Continence Society (ICS) pelvic organ prolapse quantification (POP-Q). The second method was the use of ultrasonography in the quantification of anterior, middle, and posterior compartment prolapse. RESULTS Nulliparae women exhibited the lowest probability of POP (POP-Q: cystocele of 15.6%, uterine prolapse of 11.1%, rectocele of 20.0%; ultrasound exam: 6.7%, 8.9%, 13.3% in sequence), while women with forceps delivery had the highest probability of POP (POP-Q: 59.6%, 50.8%, 63.2% in sequence; ultrasound exam: 45.6%, 52.6%, 42.1% in sequence). Regarding the correlation between POP and delivery mode, the adjusted odds ratio was 2.40 (95%CI: 1.301~4.590) and 3.20 (95%CI: 1.651~6.121) in the normal vaginal delivery group and forceps group, respectively, compared with the cesarean group. CONCLUSIONS Four-dimensional pelvic floor ultrasonography can be used as a preferred method in evaluating POP. Regarding the relationship between delivery mode and POP, there is a significant correlation between vaginal delivery and POP.