Antenatal and Postnatal Screening for Pelvic Floor Dysfunction Using an Electronic Patient Reported Outcome Measure.

Abstract

Introduction and hypothesis: Pregnancy and childbirth are established causes of pelvic floor dysfunction (PFD), but screening for antenatal and postnatal PFD is not routine in the United Kingdom. This study aimed to identify antenatal and postnatal women with PFD using a validated electronic patient reported outcome measure (PROM) and provide targeted intervention based on symptom scores.

Methods: During the evaluation period, 15,093 patients across three NHS hospitals were invited to complete ePAQ-Pelvic Floor. Invites were sent electronically after ultrasound confirmed viable pregnancy and 16 weeks postnatal. Respondents with scores 50-79 in any domain were triaged to review by a therapy assistant practitioner; scores > 80 to a specialist physiotherapist or urogynaecologist. Responses were divided into antenatal and postnatal cohorts. Mann-Whitney tests were used to assess differences in mean domain scores, with odds ratios calculated for symptom presence (domain score > 0).

Results: A total of 3366 PROMs were completed (response rate 22.3%); 1804 antenatal and 806 postnatal respondents gave consent to data analysis. Mean ages, BMI and parity were 30.3, 27.1 and 0.7 (antenatal) and 31.2, 27.8 and 1.7 (postnatal). Six hundred one patients were triaged to physiotherapy assistants and 150 to specialist review based on symptom scores. Mean domain scores for stress urinary incontinence, bowel continence, pelvic organ prolapse, dyspareunia, body image and general sex life were all significantly worse in postnatal women (p < 0.0001).

Conclusions: Antenatal and postnatal patients are at risk of PFD and using electronic PROMs may aid identification of affected women. Further research is needed into optimal instruments, acceptability and improving response rates.