Use of the Pelvic Organ Prolapse staging system of the International Continence Society, American Urogynecologic Society, and Society of Gynecologic Surgeons in perimenopausal women

• Published in: American journal of obstetrics and gynecology 1999-12, Vol.181 (6), p.1324-1328
• Main Authors: Bland, Deirdre R., Earle, Brenda B., Vitolins, Mara Z., Burke, Gregory
• Format: Article
• Language: English
• Subjects: Female; Grading system; Humans; incontinence; Middle Aged; Predictive Value of Tests; Premenopause; prolapse; Reference Values; Risk Factors; Surveys and Questionnaires; Urinary Incontinence - etiology; Uterine Prolapse - classification; Uterine Prolapse - complications; Uterine Prolapse - pathology
• ISSN: 0002-9378
• DOI: 10.1016/S0002-9378(99)70371-6

Objectives: This study was undertaken to apply the standardized Pelvic Organ Prolapse staging system to perimenopausal women to obtain normative data and to determine any effects of risk factors for incontinence and prolapse on Pelvic Organ Prolapse staging system scores. Study Design: Two hundred forty-one women aged 45 to 55 years who were seen for perimenopausal care were evaluated in the dorsal lithotomy position for pelvic prolapse at enrollment and again at 12 months. Prolapse was scored according to the Pelvic Organ Prolapse staging system, as approved by the International Continence Society. All subjects completed questionnaires to obtain demographic data, reproductive history, and gynecologic history. Data were evaluated with the Mann-Whitney rank sum test and with 1-way analysis of variance on ranks. Results: The subjects had a mean parity of 2.2 and a mean weight of 72.4 kg. Hysterectomy had been performed in 28% of the women. Urinary incontinence was reported by 66% of the women at enrollment. Mean prolapse scores that described the position of the cervix, the position of the posterior fornix, and the total vaginal length were significantly changed by the 1-year follow-up, with scores reflecting increased prolapse. The mean score at point Ba, which represents the proximal portion of the anterior vaginal wall, was significantly lower, consistent with decreased prolapse at this site. History of smoking, prior hysterectomy, weight, parity, and incontinence at enrollment did not significantly correlate with any of the 9 measured prolapse points. Conclusions: Normative data for the Pelvic Organ Prolapse staging system of the International Continence Society, American Urogynecologic Society, and Society of Gynecologic Surgeons were measured in a group of perimenopausal women. Apparent increases in prolapse at points C, D, and tvl may reflect changes in vaginal size rather an increase in uterine or vaginal vault prolapse. This variability may confound the use of the Pelvic Organ Prolapse staging system in longitudinal studies involving perimenopausal women. (Am J Obstet Gynecol 1999;181:1324-8.)