The recovery of pelvic organ support during the first year postpartum.

OBJECTIVE: Compare changes in pelvic organ prolapse (POP) from 36-38 weeks of gestation to 1 year postpartum after unlaboured cesarean delivery(UCD)and trial of labour (TOL). DESIGN: Prospective observational cohort study. SETTING: Wenzhou Third People's Hospital, Wenzhou, Zhejiang, China. POPULATION: Nulliparous women undergoing UCD or TOL. METHODS: Pelvic organ prolapse was assessed at 36-38 weeks of gestation, then at 6 weeks, 6 months and 1 year postpartum, using the Pelvic Organ Prolapse Quantification (POPQ) system. MAIN OUTCOME MEASURES: Postpartum POP status in UCD and TOL determined by POPQ measurements over time. RESULTS: Points Aa (Ba) determined the final stage assignment in most cases. Stage II POP was present in 35% and 37% of women in UCD and TOL at 36-38 weeks of gestation. After delivery, the likelihood of stage II POP declined during the first year postpartum in the whole cohort. The TOL group was much less likely to recover from stage II POP compared with the UCD group (odds ratio 0.04, 95% confidence interval 0.01-0.18) after adjustment for POP status at 36-38 weeks of gestation, age, first-trimester body mass index, newborn birthweight, educational level, gravidity and smoking status. With the exception of age, education and gravidity, these covariates were also independent predictors of postpartum POP. CONCLUSION: Factors unique to labour and delivery lead to sustained pelvic floor relaxation postpartum. Pelvic organ prolapse at 36-38 weeks of gestation, and higher first-trimester body mass index also appear to predict long-term POP. Further investigation into mechanisms leading to persistent or progressive POP after TOL are warranted. In addition, caution is needed in generalising the findings due to the single-centre design.

Effects of age, menopause, and comorbidities on neurological function of the female genitalia.

The aim of this study was to investigate the effects of age, menopause, and comorbidities on neurological function of the female genitalia using a noninvasive, validated technique. In all, 58 consecutive women were enrolled in the study. Biothesiometry was performed at five genital sites and one peripheral site with S2 dermatome distribution. Kruskal-Wallis one-way ANOVA on ranks was used to evaluate the relationship between age and vibratory sensation. Bivariate and regressional analyses were performed to evaluate the effects of age, menopause and comorbidities on genital sensation. The mean age was 44.6+14.8 y (range 20-78 y). Vibration thresholds increased with advancing age at all six sites. Multilinear regression analysis indicated that menopause and increasing age negatively affect sensation. History of herniated lumbar disc, vaginal delivery, and diabetes variably affected genital sensation. There is a significant increase in vibration thresholds (indicating worsening neurological function) in women as they age and undergo menopause. Biothesiometry is a technique for evaluating genital neurological function in women with coexisting morbidities.