Case-control study of etiologic factors in the development of severe pelvic organ prolapse

The aim of this case-control study was to identify etiologic factors predic tive for the development of severe pelvic organ prolapse. Three hundred and sixty-eight controls from a database describing pelvic organ support ill t he general population were identified as having known good pelvic organ sup port. Eighty-seven cases were identified from a urogynecology clinic with s evere pelvic organ prolapse. The risk of severe prolapse was modeled using stepwise multiple logistic regression analysis. Additional analyses using c hi (2) and two-sample t-tests were conducted to determine differences in me ans for individual variables. Variables examined included age, gravidity, p arity, number of vaginal deliveries, weight of largest infant delivered vag inally, menopause status, race, body mass index prior to pelvic surgery, an d medical illnesses. The following four variables were selected in the regr ession analysis as predicting severe prolapse: age, weight of largest vagin al delivery, hysterectomy and previous prolapse surgery. Other variables th at demonstrated statistically significant differences between groups by chi (2) and two-sample t-tests were gravidity, parity, number of vaginal deliv eries, menopausal status, race, history of incontinence surgery and the pre sence of hypertension. Variables that did not demonstrate any significant d ifferences were body mass index, the presence of chronic obstructive pulmon ous disease and diabetes mellitus. Advancing age, increasing weight of infa nts delivered vaginally, a history of hysterectomy and a history of previou s prolapse surgery were found to be the strongest etiologic predictors of s evere pelvic organ prolapse in our population.