Incidence, characteristics, and maternal outcomes of pregnancy with uterine prolapse.

BACKGROUND: Gravid uterine prolapse refers to abnormal descent of the uterus during pregnancy. Gravid uterine prolapse is a rare pregnancy complication and its clinical characteristics and obstetric outcomes are not well understood.

OBJECTIVE: To assess the national-level incidence, characteristics, and maternal outcomes of pregnancy complicated by gravid uterine prolapse.

STUDY DESIGN: This retrospective cohort study queried the Healthcare Cost and Utilization Project's National Inpatient Sample. The study population was 14,647,670 deliveries from 1/2016-12/2019. The exposure assignment was the diagnosis of uterine prolapse. The co-primary outcome measures were incidence rate, clinical and pregnancy characteristics, and delivery outcome of patients with gravid uterine prolapse. The inverse probability of treatment weighting cohort was created to mitigate the difference in pre-pregnancy confounding factors, followed by adjusting for pregnancy and delivery factors.

RESULTS: The incidence of gravid uterine prolapse was one in 4,209 deliveries (23.8 per 100,000). In a multivariable analysis, older age (Age ≥40 years, adjusted-odds ratio [aOR] 3.21, 95% confidence interval [CI] 2.70-3.81), and age 35-39 years, aOR 2.66, 95%CI 2.37-2.99), Black (aOR 1.48, 95%CI 1.34-1.63), Asian (aOR 1.45, 95%CI 1.28-1.64), and Native American (aOR 2.17, 95%CI 1.63-2.88) individuals, tobacco use (aOR 1.19, 95%CI 1.03-1.37), grand multiparity (aOR 1.78, 95%CI 1.24-2.55), and history of pregnancy losses (aOR 2.20, 95%CI 1.48-3.26) were the patient characteristics associated with the increased risk of gravid uterine prolapse. Current pregnancy characteristics associated with gravid uterine prolapse included cervical insufficiency (aOR 3.25, 95%CI 1.94-5.45), preterm labor (aOR 1.53, 95%CI 1.18-1.97), preterm premature rupture of membrane (aOR 1.40, 95%CI 1.01-1.94), and chorioamnionitis (aOR 1.64, 95%CI 1.18-2.28). Delivery characteristics associated with gravid uterine prolapse included early-preterm delivery of <34 weeks gestation (69.1 vs 32.0 per 1,000, aOR 1.86, 95%CI 1.34-2.59) and precipitate labor (35.2 vs 20.1, aOR 1.73, 95%CI 1.22-2.44). Moreover, risks of postpartum hemorrhage (112.1 vs 44.4 per 1,000, aOR 2.70, 95%CI 2.20-3.32), uterine atony (32.0 vs 15.7, aOR 2.10, 95%CI 1.46-3.03), uterine inversion (9.6 vs 0.3, aOR 31.97, 95%CI 16.60-61.58), shock (3.2 vs 0.7, aOR 4.18, 95%CI 1.41-12.40), blood product transfusion (22.4 vs 11.1, aOR 2.06, 95%CI 1.34-3.18), and hysterectomy (7.5 vs 2.3, aOR 3.02, 95%CI 1.40-6.51) were increased in the gravid uterine prolapse group compared to the non-prolapse group. Contrary, patients with gravid uterine prolapse were less likely to deliver via cesarean compared to those without (200.6 vs 322.8 per 1,000, aOR 0.51, 95%CI 0.44-0.61).

CONCLUSION: This nationwide analysis suggests that pregnancy with gravid uterine prolapse is uncommon but is associated with several high-risk pregnancy characteristics and adverse delivery outcomes.