ORIGINAL ARTICLE Pelvic organ support several years after a first birth Caroline W. S. Ferreira 1 & Ixora K. Atan 2 & Andrew Martin 3 & Ka Lai Shek 4 & Hans Peter Dietz 3 Received: 24 October 2016 /Accepted: 14 February 2017 # The International Urogynecological Association 2017 Abstract Introduction and hypothesis Female pelvic organ prolapse is highly prevalent and childbirth has been shown to be an im- portant risk factor. The study was carried out to observe if pelvic organ support deteriorates over time following a first birth. Methods This is a retrospective review using archived data sets of women seen in the context of two prospective perinatal imaging studies. All subjects had undergone a standardised interview, a clinical examination and 4D translabial ultra- sound, 3 months and 2–5 years post-partum. Main outcome measures were pelvic organ descent and hiatal area at maxi- mum Valsalva manoeuvre. Means at the two time points were compared using paired Student’ s t test. Predictors of change over time in continuous variables were explored using linear modelling methods. Results A total of 300 women had at least two postnatal fol- low-ups. They were first seen on average 0.39 (SD 0.2, range 0.2–2.1) years and again 3.1 (SD 1.5, range 1.4–8) years after the index delivery, with a mean interval of 2.71 (SD 1.5, range 0.7–7.7) years, providing a total of 813 (300 × 2.71) woman- years of observation. On univariate analysis, there was a sig- nificant decrease in mobility over time of the bladder neck, bladder, and rectal ampulla (P = < 0.004) and hiatal area (P = 0.012). The degree of improvement was less marked in women with levator avulsion. Conclusions A significant reduction in pelvic organ descent and hiatal area was noted over a mean of 2.7 years after a first birth. Keywords Pelvic floor . Pelvic organ prolapse . Postpartum period . Ultrasonography Introduction Female pelvic organ prolapse (POP) is a form of hernia in- volving the descent of pelvic organs, i.e. the bladder (cystocele), uterus (uterine prolapse), bowel (enterocele), and rectal ampulla (rectocele) through the levator hiatus, the larg- est potential hernia portal in the human body [1]. The condi- tion is highly prevalent [2], and 11–19% of the female popu- lation may require prolapse surgery at least once during their lifetime [3]. The aetiology of POP is complex and multifactorial. Among the various risk factors, childbirth has been shown to be an important risk factor for POP [4]. Its effect may be mediated via hormonal and mechanical effects of pregnancy [5] and/or pelvic floor injury secondary to the delivery process [6]. Changes in pelvic floor morphology and function [6] may occur following childbirth owing to defective soft-tissue re- modelling, ischaemia, denervation, muscular or fascial injury [7]. Recent data suggest that trauma to the levator ani muscle might explain a large part of the epidemiological association between childbirth and POP [8]. The International Continence Society 45th Annual Meeting, Montreal, Canada, 7 October 2015, and the 25th World Congress on Ultrasound in Obstetrics and Gynecology, Montreal, Canada, October 2015 * Caroline W. S. Ferreira caroline.wanderley@ufpe.br 1 Departamento de Fisioterapia, Universidade Federal de Pernambuco, Av. Prof. Moraes Rego, 1235, Cidade Universitária, Recife, Pernambuco, Brazil CEP:50670-901 2 Universiti Kebangsaan, Kuala Lumpur, Malaysia 3 University of Sydney, Sydney, New South Wales, Australia 4 Western Sydney University, Sydney, New South Wales, Australia Int Urogynecol J DOI 10.1007/s00192-017-3297-4