Identification of risk factors for postpartum pelvic floor dysfunction in a Chinese population: a retrospective study

To identify risk factors for postpartum pelvic floor dysfunction (PFD) diagnosed at 6 weeks after delivery in a Chinese population.

This retrospective study examined data from 828 postpartum women in China, collected from January 2020 to August 2021. Multivariate analyses were employed to identify factors associated with six outcomes of PFD, including anterior vaginal wall prolapse, posterior vaginal wall prolapse, uterine prolapse, stress urinary incontinence (SUI), and impaired type I and type II muscle fiber strength.

A series of factors are considered to be associated with PFD.

Cesarean delivery significantly reduced severe anterior vaginal wall prolapse risk (OR=0.426, P＜0.001). Age, overweight (BMI ≥24.9 kg/m²), macrosomia (birth weight ≥4000g), forceps-assisted delivery, and constipation significantly increased risks of anterior and posterior vaginal wall prolapse, uterine prolapse, and SUI (all OR>1, P<0.05). Twin pregnancy reduced type I (OR=0.430, P=0.013) and type II (OR=0.385, P=0.009) muscle fiber strength but increased risks of anterior vaginal wall prolapse, uterine prolapse, and SUI. Higher parity (two or more) was correlated with higher risks of anterior (OR=2.402, P<0.001) and posterior vaginal wall prolapse (OR=2.977, P=0.0003) and SUI (OR=1.726, P=0.001). Heavy physical labor was strongly associated with posterior vaginal wall prolapse (OR=6.285, P=0.008), uterine prolapse (OR=5.264, P=0.009), and SUI (OR=3.987, P=0.024). Underweight status (BMI<18.5 kg/m²) significantly increased risks of impaired type I (OR=0.173, P<0.001) and type II muscle fiber strength (OR=0.197, P=0.0003).

This study identified significant PFD risk factors in a Chinese population, highlighting the importance of targeted prenatal, perinatal, and postpartum care to mitigate these risks. In addition to uncontrollable factors like mode of delivery, age, and parity, interventions targeting weight gain and fetal macrosomia during pregnancy and appropriate assisted delivery could mitigate the risks of PFD. Educational programs for pregnant women should emphasize a proper diet and lifestyle. For women with chronic constipation, clinical treatment should be carried out as soon as possible to avoid further aggravating the damage to the pelvic floor muscles.