Analyses of changes in postpartum pelvic floor dysfunction and associated risk factors in primigravid women before and after coronavirus disease 2019

Rong Li¹Chenxi Zhang¹Feifei Qian²Na Zhou^1,2*

• ¹Department of Nursing, Dali University, Dali, China
• ²Department of Obstetrics, Yunnan Province Third People's Hospital, Kunming, China

Background: Following the coronavirus disease 2019 (COVID-19) pandemic, The prevalence of postpartum pelvic floor dysfunction (PFD) in primipara may have changed due to SARS-CoV-2 infection, psychological pressure and other factors. Although studies have shown that COVID-19 increases the risk of unfavourable pregnancy outcomes, including pre-term labour, stillbirth and pre-eclampsia, its effects on PFD are not well understood. Methods: Using a retrospective analysis, we collected clinical data of 600 women who successfully delivered in our hospital between July 2019 and November 2019 and between January 2023 and April 2023 and those who were reviewed at 42 days following delivery (pre-COVID-19 group, 300; post-COVID-19 group, 300). Comparing the incidence of pelvic organ prolapse and postpartum PFD in primigravid women in the pre-COVID-19 and post-COVID-19 groups. Risk factors for all variables were analyzed with an independent samples proportion test, and multivariate logistic regression was employed to assess risk factors. Results: In primiparous women, the incidence of postpartum PFD was significantly higher in the post-epidemic period (P < 0.05), with rates of 58.0% and 70.3% in the pre-COVID-19 and post-COVID-19 groups, respectively. Multivariate logistic regression analysis revealed that the incidence of postpartum PFD in primigravid women was associated by vaginal deliveries (adjusted odds ratio [AOR] = 2.57, 95% confidence interval [CI]: 1.17–5.61), excessive weight gain during pregnancy (AOR = 3.26, 95% CI: 1.69–6.31), late pregnancy incontinence (AOR = 3.17, 95% CI: 1.66– 6.04), episiotomy (AOR = 4.24, 95% CI: 1.97–6.9.13), coagulation disorders (AOR = 3.23, 95% CI: 1.71–6.12) and pre-term rupture of membranes (AOR = 2.18, 95% CI: 1.15–4.13). Conclusion: The incidence of PFD in primiparous women was higher after the COVID-19 pandemic compared to the pre-pandemic period. Additionally, this study verified that vaginal birth, excessive weight gain during pregnancy, late pregnancy incontinence and episiotomy were associated with the occurrence of postpartum PFD in primiparous women during the COVID-19 prevention and control phase. Furthermore, newly identified coagulation dysfunction and pre-term membrane rupture were also associated with PFD. Based on these high-risk characteristics, early intervention steps to mitigate PFD risk should be implemented in clinical practice.