Title:
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The prevalence and obstetric antecedents of pelvic floor dysfunction.
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It has long been considered that aspects of pregnancy and child birth play a role in the
aetiology of pelvic floor dysfunction (PFD). Most women have their first pregnancy
in their 20's, yet the peak time for presentation with symptoms is 2 or 3 decades later.
The studies embodied in this thesis are designed to examine the prevalence and
antecedent risk factors ofPFD in women 20 years after their first delivery.
Unique aspects ofthe studies described here are: identification of a consecutive group
of women having their first pregnancies over a short time period in a single hospital;
the est~blishmentofcurrent contact information for these women 20 years later using
the NHS Strategic Tracing System (NSTS); the use ofa robust obstetric database, the
Standard Maternity Information System (SMIS) effective at the time of the index
pregnancies; and the use of the validated Sheffield Pelvic Floor Assessment
Questionnaire (Sheffield-PAQ© v3) to determine current symptoms and their impact
on quality of life. Mothers of index cases were also contacted to assess familial risk.
PFD was confirmed to be extremely common, with symptoms affecting half of
women 20 years after their first pregnancy; 4:10 women reported urinary incontinence
(UI), 2:10 had anal incontinence (AI), and 1:8 had prolapse. Symptoms were
troublesome in over 50% (prolapse) and over 70% CUI & AI). Logistic regression
analyses indicated that caesarean section was protective against UI, faecal
incontinence (FI) and mild prolapse. Instrumental delivery was a risk factor for flatal
and FI; obesity was a risk factor for all three symptoms. A familial risk for UI and AI
was identified.
Vaginal birth is a significant risk factor for long term symptoms ofPFD. However,
some women may have a predisposition, possibly genetic, to develop symptoms
which is independent of obstetric history.
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