General Obstetrics and Gynecology: Gynecology
Pelvic Organ Support Study (POSST): The distribution, clinical definition, and epidemiologic condition of pelvic organ support defects

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Objective

The purpose of this study was to describe the distribution of pelvic organ support in a gynecologic clinic population to define the clinical disease state of pelvic organ prolapse and to analyze its epidemiologic condition.

Study design

This was a multicenter observational study. Subjects who were seen at outpatient gynecology clinics who required an annual gynecologic examination underwent a pelvic organ prolapse quantification examination and completed a prolapse symptom questionnaire. Receiver operator characteristic curves were used to define pelvic organ prolapse with the use of symptoms and pelvic organ prolapse quantification examination measures. Standard age-adjusted univariate and multivariate logistic regression analysis were used to evaluate various relationships.

Results

The population consisted of 1004 women who were aged 18 to 83 years. The prevalence of pelvic organ prolapse quantification stages was 24% (stage 0), 38% (stage 1), 35% (stage 2), and 2% (stage 3). The definition of pelvic organ prolapse that was determined by the receiver operator characteristic curve was the leading edge of their vaginal wall that was −0.5 cm above the hymenal remnants. Multivariate analysis revealed age, Hispanic race, increasing body mass index, and the increasing weight of the vaginally delivered fetus as risk factors for pelvic organ prolapse, as defined in this population.

Conclusion

The results from this population suggest that there is a bell-shaped distribution of pelvic organ support in a gynecologic clinic population. Advancing age, Hispanic race, increasing body mass index, and the increasing weight of the vaginally delivered fetus have the strongest correlations with prolapse.

Section snippets

Material and methods

This was a multicenter, cross-sectional, observational study. Six centers around the United States that served diverse patient populations participated. The centers included 2 centers in Texas and 1 center each in Washington, North Carolina, South Carolina, and Minnesota. These 6 centers were chosen through self-selection as part of a call for multicenter research sponsored by the American Urogynecologic Society. The study was approved by the Institutional Review Board at each center, and each

Results

One thousand four women participated in the study over an 18-month period from September 1999 through March 2002. The centers served various populations: 2 centers served a primarily private gynecologic practice; 1 center combined private practice and house-staff resident clinic populations; 1 center served mainly resident house-staff clinic populations; 1 center served a military population (which included active duty and military dependents), and 1 center served as a gynecology clinic for

Comment

The current state of research regarding pelvic support defects has been hampered by the lack of a sound definition of the disease of pelvic organ prolapse. Until the disease can be defined, it cannot be recognized; until it can be recognized, little progress can made into describing its epidemiologic condition. This study was designed to document the distribution of pelvic organ support in a geographically and racially diverse group of women, to develop a meaningful definition of pelvic organ

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