1. Genital Hiatus Size and the Development of Prolapse Among Parous Women
- Author
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Joan L. Blomquist, Alvaro Muñoz, Victoria L. Handa, and Megan K. Carroll
- Subjects
Adult ,medicine.medical_specialty ,Longitudinal study ,Vaginal birth ,Urology ,030232 urology & nephrology ,Pelvic Organ Prolapse ,Article ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Humans ,Medicine ,Sex organ ,Longitudinal Studies ,Pelvic organ ,030219 obstetrics & reproductive medicine ,Cesarean Section ,business.industry ,Obstetrics ,Incidence (epidemiology) ,Obstetrics and Gynecology ,Organ Size ,Delivery, Obstetric ,Delivery mode ,digestive system diseases ,stomatognathic diseases ,Parity ,medicine.anatomical_structure ,Hymen ,Vagina ,Female ,Surgery ,business ,Cohort study - Abstract
OBJECTIVES: In cross-sectional studies, pelvic organ prolapse is strongly associated with genital hiatus size. The objective of this study was to estimate prolapse incidence by the size of the genital hiatus among parous women followed prospectively. METHODS: Data were derived from a longitudinal study of pelvic floor disorders. Participants were followed annually for 2–9 years. Genital hiatus size and prolapse beyond the hymen were assessed with annual POP-Q examinations. Kaplan-Meier methods described prolapse-free survival as a function of genital hiatus size. Accounting for changes over time in genital hiatus size, lognormal models were used to estimate prolapse-free survival by genital hiatus size. This analysis was repeated separately for women who delivered exclusively by cesarean versus those with at least one vaginal birth RESULTS: Among 1492 participants, median age at enrollment was 38 years; 153 (10.3%) developed POP over 2–9 years. The cumulative probability of prolapse increased substantially as the size of the genital hiatus increased. Lognormal models predicted that the estimated median time to develop prolapse would be 33.4 years for women with a persistent genital hiatus of 3cm; in contrast, the estimated median time to develop prolapse would be 5.8 years for a genital hiatus of ≥4.5 cm. Considering separately women who delivered by cesarean versus those with at least one vaginal birth, genital hiatus size drastically modified prolapse risk in both birth groups. CONCLUSIONS: Prolapse incidence is strongly associated with genital hiatus size, regardless of delivery mode. These findings suggest that a wider GH is an important predictor of future prolapse risk.
- Published
- 2020