Pregnancy, labor, delivery, and pelvic organ prolapse.

Objective: To compare 1) the occurrence of pelvic organ prolapse after vaginal and cesarean delivery, and 2) the susceptibility of black and white women to developing prolapse during childbirth.

Methods: Ninety-four nulliparous women were evaluated for pelvic organ prolapse at their 36-week antepartum and 6-week postpartum visits using the International Continence Society staging system. A change in International Continence Society stage from 36 weeks antepartum to 6 weeks postpartum was considered pelvic organ prolapse that developed during childbirth.

Results: Forty-three (46%) of 94 nulliparous women had pelvic organ prolapse at their 36-week antepartum visit. Twenty-four (26%) had a stage II prolapse. Six weeks postpartum, 13 of 41 (32%) who had spontaneous vaginal delivery and nine of 26 (35%) who had cesarean delivery during active labor developed a new prolapse (P =.805). Seven (17%) who had spontaneous vaginal delivery and two (8%) who had cesarean delivery during active labor revealed a more severe prolapse (P =.237). Eighteen (33%) of 54 black and 17 (43%) of 40 white women developed a new prolapse during childbirth (P =.363). Eight (15%) black and six (15%) white women revealed a more severe prolapse (P =.980).

Conclusion: Our data suggest that elective cesarean is only partially effective in preventing pelvic organ prolapse. Cesarean delivery during active labor and vaginal delivery had a similar effect on the maternal pelvic support. This indicates that prolapse developed during the first and not the second stage of labor. Black women are as susceptible to developing prolapse during childbirth as their white counterparts.