Assessment of risk factors for pelvic organ prolapse using dynamic MRI combined with clinical data

Objective To investigate the risk factors for pelvic organ prolapse (POP) using dynamic MRI in combination with clinical data. Materials and methods Postpartum women who visited between August 2023 and October 2024 were enrolled. Patients were classified into the POP group if the lowest point of the anterior and/or middle compartment organs descended more than 1 cm below the pubococcygeal line (PCL) during straining, and into the non-POP group otherwise. Statistical analysis was conducted to compare MRI parameters and clinical data between the two groups. Results A total of 94 cases were assigned to the POP group and 276 to the non-POP group. Univariate and Multivariate logistic regression identified mode of delivery, straining H-line length, H-line difference, and M-line difference as independent risk factors for POP. The cutoff values for straining H-line length, H-line difference, and M-line difference were 5.45 cm, 0.65 cm, and 0.75 cm, respectively. Among these, the H-line difference had the highest area under the curve (AUC = 0.889) and the highest Youden index (0.606). Both H-line difference (r = 0.577, p < 0.001) and M-line difference (r = 0.531, p < 0.001) showed a positive correlation with the occurrence of POP. Conclusion Dynamic MRI combined with clinical data provides an accurate diagnostic approach for POP. Patients with a history of vaginal delivery, straining H-line > 5.45 cm, H-line difference > 0.65 cm, and M-line difference > 0.75 cm should be considered at high risk and may benefit from early clinical intervention. Critical relevance statement By integrating clinical data, we aimed to identify risk factors associated with prolapse, thereby providing scientific evidence to support early detection, timely intervention, and preventive strategies for POP in clinical settings. Key Points This study established a comprehensive framework for assessing the risk of pelvic organ prolapse (POP), thereby enhancing diagnostic precision and clinical applicability. The H-line difference demonstrated the highest predictive value for POP, with the greatest AUC (0.889) and the highest Youden’s index (0.606). H-line and M-line differences were identified as independent risk factors for POP, with cutoff values of 0.65 cm and 0.75 cm.