Obstetric trauma in the etiology of genital prolapse: Clinical and pathogenetic analysis. Case control study

Background. Pelvic organ prolapse (POP) is a significant medical and social problem with a high prevalence and an upward trend in the incidence. It significantly impacts the quality of life and tends to relapse after surgical treatment of the supporting structures of the pelvic floor. Despite the proven association of POPs with obstetric traumas, their role remains poorly understood. Aim. To assess the frequency of obstetric traumas in patients with POP and determine the directions for their prevention. Materials and methods. A prospective case-controlled study was conducted involving 210 women (150 patients with POP and 60 control patients) who underwent surgical treatment in 2023–2024. Obstetric history was reviewed, including perineal trauma, episio-/perineotomy, large foetus, type of delivery. Results. The absolute number of births did not affect the risk of POP (p>0.05); however, the complicated course of labor was a key predictor; in patients with obstetric traumas, the risk was 4.2 times higher (relative risk – RR 4.20, 95% confidence interval – CI 1.68–8.78), with episio-/perineotomy – 8.8 times higher (RR 8.80, 95% CI 1.9–18.6), with fetal macrosomy – 5.4 times higher (RR 5.40, 95% CI 3.35–13.43). Cesarean section did not show a protective effect on POP prevention (p>0.05). Conclusion. Obstetric traumas are a significant but partially modifiable risk factor for POP. Prevention of macrosomia, avoidance of routine episiotomy, and minimization of obstetric traumas are key areas for reducing the POP incidence. © 2025 Elsevier B.V., All rights reserved.