Childbirth and prolapse: long-term associations with the symptoms and objective measurement of pelvic organ prolapse
Open accessAbstract
Objectives: To investigate prolapse symptoms and objectively measured pelvic organ prolapse, 12 years after childbirth, and association with delivery mode history. Design: Twelve‐year longitudinal study. Setting: Maternity units in Aberdeen, Birmingham and Dunedin. Population: Women dwelling in the community. Methods: Data from women were collected 12 years after an index birth and women were invited for examination. Logistic regression investigated associations between risk factors and prolapse symptoms and signs. Main outcome measures: Prolapse symptom score (POP‐SS); objectively measured prolapse (POP‐Q). Results: Of 7725 continuing women, 3763 (49%) returned questionnaires at 12 years. The median POP‐SS score was 2 (IQR 0–4). One or more forceps deliveries (OR 1.20, 95% CI 1.04–1.38) and a body mass index (BMI) over 25 were associated with higher (worse) POP‐SS scores, but age over 25 years at first delivery was associated with lower (better) scores. There was no protective effect if all deliveries were by caesarean section (OR 0.84, 95% CI 0.69–1.02). Objective prolapse was found in 182/762 (24%) women. Women aged over 30 years when having their first baby and parity were significantly associated with prolapse. Compared with women whose births were all spontaneous vaginal deliveries, women who had all births by caesarean section were the least likely to have prolapse (OR 0.11, 95% CI 0.03–0.38), and there was a reduced risk after forceps or a mixture of spontaneous vaginal delivery and caesarean section. Conclusions: These findings are at odds with each other, suggesting that prolapse symptoms and objective prolapse may not be in concordance, or are associated with different antecedent factors. Further follow‐up is planned.
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The pooled odds ratio for BMI ≥30 vs <25 kg/m2 was statistically significant for primary pelvic organ prolapse (OR 1.75; 95% CI 1.17-2.62).
“The pooled ORs for BMI 25e30 vs <25 kg/m 2 and !30 vs <25 kg/m 2 were statistically significant (OR, 1.52; 95% CI, 1.07e2.1534,37 and OR, 1.75; 95% CI, 1.17e2.62,34,37 respectively).”
From Risk factors for primary pelvic organ prolapse and prolapse recurrence: an updated systematic review and meta-analysis (2022) · cites this paper as [34]
Table 4 reports an obese-versus-normal BMI odds ratio of 1.48 (95% CI 0.91–2.40) for objectively measured prolapse, which is not statistically significant. The Objectively measured prolapse (POP-Q) section explicitly states that current BMI was not associated with objectively measured prolapse. This paper does not report the claimed pooled OR of 1.75. (LLM, conf=0.88)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredCesarean delivery was statistically significantly protective against primary pelvic organ prolapse compared with normal vaginal delivery (n=2, pooled OR 0.08; 95% CI 0.03-0.20).
“Cesarean delivery was statistically significantly protective against primary POP when compared with normal vaginal delivery (n¼2, pooled OR, 0.08; 95% CI, 0.03e0.20)”
From Risk factors for primary pelvic organ prolapse and prolapse recurrence: an updated systematic review and meta-analysis (2022) · cites this paper as [34]
The Objectively measured prolapse (POP-Q) section reports a statistically significant association in the claimed direction: women whose deliveries were all by cesarean had less objectively measured prolapse than women whose deliveries were all spontaneous vaginal births. But this is one longitudinal study, not a two-study pooled estimate; its reported OR is 0.11 (95% CI 0.03–0.38), not 0.08 (0.03–0.20). The paper also distinguishes objective prolapse from symptoms, for which the cesarean association was not statistically significant. (LLM, conf=0.90)
Experimental — accuracy not yet measuredForceps delivery was reported as a significant risk factor and as a significant protective factor for primary pelvic organ prolapse compared with normal vaginal delivery.
“Forceps delivery was reported as a significant risk factor and as a significant protective factor for primary POP compared with normal vaginal delivery.”
From Risk factors for primary pelvic organ prolapse and prolapse recurrence: an updated systematic review and meta-analysis (2022) · cites this paper as [34]
Table 3 reports significantly worse prolapse symptom scores among women with at least one forceps delivery than among women whose deliveries were all spontaneous vaginal deliveries. Table 4 reports significantly lower odds of objectively measured prolapse for the forceps group against the same comparator. The claim omits that these are different outcomes and describes both as findings about primary pelvic organ prolapse, which the paper does not establish. (LLM, conf=0.88)
Experimental — accuracy not yet measuredNo significant association was found between vacuum delivery and primary pelvic organ prolapse (n=2, pooled OR 0.88; 95% CI 0.45-1.73).
“No significant association was found between vacuum delivery and primary POP (n¼2, pooled OR, 0.88; 95% CI, 0.45e1.73)”
From Risk factors for primary pelvic organ prolapse and prolapse recurrence: an updated systematic review and meta-analysis (2022) · cites this paper as [34]
Table 4 (page unavailable) reports no statistically significant association between vacuum-delivery history and objectively measured prolapse (OR 0.71, 95% CI 0.35–1.42; P=0.338). The paper is a single longitudinal study; it does not report the claimed two-study pooled OR of 0.88 or its confidence interval. (LLM, conf=0.90)
Experimental — accuracy not yet measuredThe pooled odds ratio for BMI 25-30 vs <25 kg/m2 was statistically significant for primary pelvic organ prolapse (OR 1.52; 95% CI 1.07-2.15).
“The pooled ORs for BMI 25e30 vs <25 kg/m 2 and !30 vs <25 kg/m 2 were statistically significant (OR, 1.52; 95% CI, 1.07e2.1534,37 and OR, 1.75; 95% CI, 1.17e2.62,34,37 respectively).”
From Risk factors for primary pelvic organ prolapse and prolapse recurrence: an updated systematic review and meta-analysis (2022) · cites this paper as [34]
Table 4 reports an elevated odds ratio for overweight women and objectively measured prolapse, but it is 1.33 (95% CI 0.90–1.96) and not statistically significant. The paper does not report the claimed pooled OR of 1.52 (95% CI 1.07–2.15); its significant BMI association concerns prolapse symptoms instead (Table 3). (LLM, conf=0.83)
Experimental — accuracy not yet measured
Higher BMI as a categorical variable was a significant risk factor for primary pelvic organ prolapse in 4 studies, and 2 studies showed no statistically significant association.
“Higher BMI as a categorical variable was a significant risk factor for primary POP in 4 studies 29,35e37 , and 2 studies showed no statistically significant association.”
From Risk factors for primary pelvic organ prolapse and prolapse recurrence: an updated systematic review and meta-analysis (2022) · cites this paper as [34]
Table 4 reports no statistically significant association between categorical BMI and objectively measured prolapse (overall p=0.826), consistent with the claim's null-association portion. The Prolapse symptoms (POP-SS) section reports significant associations for overweight and obesity, but those concern symptom scores, not objectively measured POP. This paper alone does not establish the claimed counts of four significant studies and two nonsignificant studies. (LLM, conf=0.84)
Experimental — accuracy not yet measuredAge at first delivery was reported by 3 studies, of which 1 study reported ages above 30 as a risk factor compared with age 24.
“Age at first delivery was reported by 3 studies, of which 1 study 34 reported ages above 30 as a risk factor compared with age 24”
From Risk factors for primary pelvic organ prolapse and prolapse recurrence: an updated systematic review and meta-analysis (2022) · cites this paper as [34]
The pooled odds ratio for forceps delivery was not statistically significant (n=2, pooled OR 1.05; 95% CI 0.57-1.94).
“The pooled OR was not statistically significant (n¼2, pooled OR, 1.05; 95% CI, 0.57e1.94).”
From Risk factors for primary pelvic organ prolapse and prolapse recurrence: an updated systematic review and meta-analysis (2022) · cites this paper as [34]
The Analysis section describes regression within a longitudinal cohort, not a pooled analysis of two studies. Tables 3 and 4 report forceps-delivery ORs of 1.20 and 0.64 for different prolapse outcomes; neither gives the claimed pooled OR of 1.05 (95% CI 0.57–1.94). Searches for the pooled estimate and a two-study analysis found no supporting passage in our copy. Page numbers were not available. (LLM, conf=0.76)
Experimental — accuracy not yet measured
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- Authors
- Glazener, C., Elders, A., MacArthur, C., Lancashire, R., Herbison, P., Hagen, S., Dean, N., Bain, C., Toozs‐Hobson, P., Richardson, K., McDonald, A., McPherson, G., Wilson, D., & for the ProLong Study Group
- Affiliations
- University of Aberdeen (GB)
- University of Birmingham (GB)
- University of Otago (NZ)
- Glasgow Caledonian University (GB)
- York Hospital (GB)
- Aberdeen Royal Infirmary (GB)
- Birmingham Women's Hospital Birmingham Women's NHS Foundation Trust Edgbaston Birmingham UK
- Corresponding author
- Glazener, C
- Venue
- BJOG: An International Journal of Obstetrics & Gynaecology
- Publisher
- Wiley
- Published
- 2012-11-27
- Volume
- 120
- Issue
- 2
- Pages
- 161-168
- ISSN
- 0306-5456 (ISSN-L)
- 1470-0328
- 1471-0528
- OpenAlex
- W2059980005
- Semantic Scholar
- 102fec439707560ef11408a720d7b1fadd6c020e
- Cited by
- 145
- References
- 16
- Citations by year
- 2026: 3 · 2025: 7 · 2024: 3 · 2023: 6 · 2022: 8 · 2021: 12 · 2020: 18 · 2019: 13 · 2018: 14 · 2017: 20 · 2016: 10 · 2015: 14 · 2014: 10 · 2013: 6 · 2012: 1
- FWCI
- 7.60
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Locations
- BJOG An International Journal of Obstetrics & Gynaecology (publishedVersion)
- PubMed (publishedVersion)
- Aberdeen University Research Archive (Aberdeen University) (submittedVersion)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
- ResearchOnline (Glasgow Caledonian University) (submittedVersion)
- Topics
- Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
- Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pregnancy-related medical research
- Keywords
- pelvic organ prolapse, childbirth, mode of delivery, cesarean section, forceps delivery, vaginal delivery, prolapse symptoms, POP-Q, body mass index, parity, age at first birth, long-term outcomes
- MeSH terms
- Adult, Cesarean Section, Extraction, Obstetrical, Female, United Kingdom, Health Surveys, Humans, Longitudinal Studies, Middle Aged, New Zealand, Pregnancy, Surveys and Questionnaires, Risk Factors, Logistic Models, Parturition, Delivery, Obstetric, Pelvic Organ Prolapse
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