The follow-up of the symptoms of pelvic floor disorders during pregnancy is an important factor in treating and preventing the onset of these diseases in the postpartum period. Studies show that there is correlation between the history of dysfunctions during pregnancy and their onset/worsening in the puerperium [1]. There is a variation in symptoms of PF dysfunction in pregnant and postpartum women: pregnant women in the third trimester and postpartum women in the first month postpartum have worse symptoms, but it tends to gradually decrease during the first postpartum year [2]. Despite its importance, there are still few studies that assess and monitor the development of these symptoms during pregnancy and the postpartum using validated instruments capable of assessing and quantifying self-reported symptoms over time. So, our study was the first one that aimed to assess the pelvic floor dysfunction symptoms in our population throughout pregnancy and postpartum.

Cross-sectional study, clinical, not-surgical. After consent, 148 women were evaluated, of which 46 were pregnant for up to 28 weeks (G_28); 28 pregnant women gestational age between 28 and 40 weeks (third trimester) (G_40); 48 women in the postpartum period of up to 24 weeks (6 months) (PP_24); and 26 postpartum women between 24 and 60 weeks (6 months to 1 year and 3 months) (PP_60). The post hoc sample size analysis, with an effect size of 0.65, with a sample of 148 participants, and an alpha of 5% for ANCOVA with 4 groups, we obtained more than 80% of power. The assessment was performed using the Australian Pelvic Floor Questionnaire, which contains 42 questions divided into four domains (urinary function, intestinal function, prolapse and sexual function). To compare demographic data (age, parity and gravidity), one-way ANOVA was used. ANCOVA was used to compare the domains of the questionnaire, with parity set as a covariate. Statistically significant differences were considered when p<0.05.

The one-way ANOVA showed effect for the parity between groups (p<0.001), therefore this variable was set as covariate to isolate the influence of parity on pelvic floor dysfunction symptoms.
ANCOVA showed significant differences for the Urinary (p=0.01) and Sexual (p=0.03) functions between groups (table 1). The post hoc comparisons for the Urinary Function showed difference between groups G_28 and PP_24 [p tukey= 0.02, Cohen’s d= 0.64 (CI 0.19-1.08)], where the G_28 group has a mean of 6.98 points and the PP_24, a mean of 4.56 points. We also had a tendency of significance in the difference between G_40 and PP_24 for the Urinary Function, with p=0.06, Cohen’s d= 0.65 (CI 0.13-1.17)- note that the confidence interval doesn’t contains the zero, so we may accept the p as significant- where the G_40 has a mean of 6.68 points and the PP_24 a mean of 4.56 points.
The post hoc for Sexual Function domain showed a significant difference between groups G_40 and PP_60 [p tukey=0.02, cohen’s d= 0.85 (CI 0.85-1,43)], where the G_40 group has a mean of 1.43 points and the PP_60 a mean of 3.85 points. We also found a tendency of significance for the difference between G_28 and PP_60 with p=0.07, Cohen’s d= 0.61 (CI 0.11-1.13)- note that again the confidence interval doesn’t contains the zero, so we may accept the p as significant- the G_28 group has a mean of 2.09 points and the PP_60 a mean of 3.85 points (table 1).

The results showed an interesting difference between pregnant and postpartum women. Although there was no difference for the total score, when we compared each domain separately we found that pregnant women with gestational age up to 28 weeks have more symptoms related to urinary dysfunction than parous women up to 6 months postpartum. And we also found the tendency for the pregnant with gestational age between 28 and 40 weeks to have more urinary dysfunction than parous women up to 6 months postpartum. Another interesting finding was related to sexual function, pregnant women with gestational age between 28 and 40 weeks have less symptoms of sexual dysfunction than parous women, 6 to 15 months after giving birth. We also found a tendency of pregnant women with gestational age up to 28 weeks to have less symptoms of sexual dysfunction than parous women, 6 to 15 months after delivery.

This study demonstrates that there are variations in the occurrence of PF disorders throughout pregnancy and the postpartum period, not only for urinary symptoms (usually monitored) but also for sexual function. This suggests that the follow-up of women during these periods can bring benefits in terms of prevention and early treatment. In this sense, more studies are needed to better map the trend of these changes so that this monitoring is more effective.

SPELLACY CE. Urinary incontinence in pregnancy and the puerperium. J Obst Gynecol Neonatal Nurs, v. 30, n.6, p. 634-41, 2008.
MILSOM I, Altman D, Cartwright R, Lapitan MC, Nelson R, Sjöström S, et al. Epidemiology of urinary incontinence (UI) and other lower urinary tract symptoms (LUTS), pelvic organ prolapse (POP) and anal incontinence (AI). In: Abrams P, Cardozo L, Wagg A, Wein A, editors(s). Incontinence: 6th International Consultation on Incontinence, Tokyo, September. 6th edition. Vol. 1. Bristol (UK): International Continence Society (ICS) and International Consultation on Urological Diseases (ICUD), 2017:1-141.