Postpartum Pelvic Organ Prolapse in Young Primiparous Women
Drs. J. I. Schaffer, M. Nihira, B. Vakili, D. McIntire, K. Levino
University of Texas Southwestern
Dallas, Texas

Objective: To evaluate the pelvic floor after the first vaginal delivery and to determine the effect of episiotomy, laceration, forceps, macrosomia, and prolonged 2^nd stage on the postpartum pelvic floor exam.
Materials and Methods: Eighty-nine primiparous women presenting to a pelvic floor research clinic from 2 to 8 weeks postpartum underwent POPQ examination by two urogynecology nurse practitioners.  The median value for each POPQ point was calculated.  A computerized obstetrical database was used to identify episiotomy, 3^rd or 4^th degree laceration, forceps, macrosomia (>4000g) and prolonged 2^nd stage (>2hours) in each patient.  Statistical analysis with the Wilcoxen signed-rank test was used to compare the effect of each obstetrical factor on each POPQ point.
Results: All deliveries were by the vaginal route.  The mean age was 21.6 years (range 16-31).  Ninety-one percent were Hispanic, 7% African-American and 2% Caucasian.  The median POPQ values were: AA –2cm, BA –2cm, C –7cm, GH 3cm, PB 4cm, TVL 10cm, AP –3cm, BP –3cm, D  –9cm.  In 41% of patients, point AA ranged from  –1 to +1 and in 36% of patients point BA ranged from –1 to +1, indicating Stage 2 prolapse of the anterior vaginal wall.  Points AP and BP ranged from  –1 to +1 in only 6% of subjects.  Points C and D did not reach –1cm in any patient.  Episiotomy was performed in 27 patients and forceps in 6 patients.  Eleven patients had a 3^rd or 4^th degree laceration.  Macrosomia was present in 6 patients and prolonged 2^nd stage occurred in 3 patients.  Statistically significant differences in POPQ values were not seen for any of these obstetrical variables.
Conclusions: In this study of young primiparous women, anterior vaginal wall prolapse was very common in the immediate postpartum period.  Cervical, apical and posterior vaginal wall prolapse was very uncommon.  This suggests that the supportive connective tissue, musculature and neurologic innervation of the anterior vaginal wall may be more vulnerable to the forces of vaginal delivery than the posterior vaginal wall or apex. Further study is needed to determine the prevalence of prolapse in nulliparous women and the influence of specific obstetrical factors.
Key Words: Pelvic organ prolapse, vaginal delivery