Objectives: Three-dimensional ultrasound has shown to be a reliable and reproducible method for visualization of morphologic changes to the female levator ani muscle.
Aim of this study was to evaluate the relationship of persisting pelvic floor disorders 18-24 months after the first delivery, biometrical measurements of the pelvic floor and mode of delivery.
Methods: In this prospective observational study, 130 primiparae were recruited (all of them Caucasians with singleton pregnancy and cephalic presentation). A three-dimensional perineal ultrasound was performed on the second day and 18-24 months after their first delivery with standardized settings. Volumes were obtained at rest and on valsalva maneuver, biometric measurements of the levator hiatus were determined in axial and sagittal planes. Different obstetric and constitutional parameters were obtained from our clinical files, a standardized questionnaire was used to evaluate persisting pelvic floor disorders 18-24 months after the first delivery.
Results: Follow-up rate was 59 % (n = 77). The biometric measurements showed a significantly larger hiatal area in the vaginal delivery group even two years after the first delivery (p< 0.01), whereas subgroup analysis of the vaginal (spontaneous vs. operative vaginal) and cesarean (primary= elective vs. secondary= after onset of labor) delivery groups did not reach significance. Although there was no statistic correlation to delivery mode, women with a persisting stress urinary incontinence two years after first delivery had a larger hiatal area than women without any problems (p< 0.01). No significant differences were found in women with bladder urgency or dyspareunia.
Conclusions: Three-dimensional transperineal ultrasound is easily accessible and can provide useful information on morphologic changes of the female pelvic floor. In our study, women with vaginal or vaginal operative delivery had a significant larger hiatal area and axial distension than women who delivered by cesarean section even two years after their first delivery. Performing three-dimensional ultrasound after the first delivery may help to identify women at high-risk for persisting pelvic floor disorders.
Written by:
Falkert A, Willmann A, Endreß E, Meint P, Seelbach-Göbel B. Are you the author?
Krankenhaus Barmherzige Brüder - Frauenklinik St. Hedwig, Department of Obstetrics and Gynecology, University of Regensburg/Germany, Steinmetzstrasse 1 - 3, D-93049 Regensburg.
Reference: Ultrasound Obstet Gynecol. 2012 Jun 29. Epub ahead of print.
doi: 10.1002/uog.11214
PubMed Abstract
PMID: 22745047
UroToday.com Stress Urinary Incontinence Section
