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COVID-19 has significantly impacted the world and Nepal is no exception. The pandemic has caused a reduction in health service delivery, especially for women’s health conditions, resulting in an increase in challenges for an already vulnerable group. Maternity care, reproductive health services, preventive interventions, nutritional advice and mental health care are not being addressed and with an increase in domestic violence, the health and wellbeing of women in Nepal is precarious and needs to be addressed immediately.

POP is common in Nepali women attending a general gynaecology clinic, with a high prevalence of uterine prolapse (40%). Uterine retroversion was seen in 60% and was associated with uterine prolapse. Patterns of POP in Nepal seem to be different from patterns observed in Western populations.

Aim: To investigate whether pelvic floor muscle (PFM) morphological changes obtained through four-dimensional translabial ultrasound (4D TLUS) correlate with a PFM contraction as evaluated by digital palpation and PFM electromyographic activity evaluated by surface electromyography (sEMG). The secondary objective was to investigate which ultrasound parameter is more strongly associated with digital palpation. Methods:This cross-sectional study included 210 women and their PFMs were evaluated by digital palpation (graded according to the Modified Oxford Scale), sEMG and 4D TLUS. Offline analysis of ultrasound volume datasets was performed for measuring the change in levator plate angle, bladder neck elevation, hiatal area narrowing, puborectalis strain, and puborectalis muscle thickness at rest and during PFM contraction. Statistical analysis included Kruskal-Wallis, Dunn, and Spearman's tests in addition to univariate and multivariate logistic regression, adopting a significance level of 5%. Results: A weak but significant correlation between the change in levator plate angle and sEMG (P = .04; r = 0.14) was found. All 4D TLUS measurements, except the puborectalis muscle thickness, significantly correlated with digital palpation (P < .0001); with the puborectalis strain and the change in levator plate angle having the strongest combined parameters associated with digital palpation (R 2 = 21.77%), despite the low coefficient of determination. Conclusion:We found that 4D TLUS significantly correlates with digital palpation and sEMG, being the change in the levator plate angle the parameter that best correlates with both methods. While digital palpation is essential during a PFM functional assessment, 4D TLUS is recommended as a beneficial noninvasive clinical tool for a more in-depth evaluation. K E Y W O R D S digital palpation, electromyography, pelvic floor, physiotherapy, translabial ultrasound

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ObjectivesPelvic organ prolapse is very common among women in Nepal, especially uterine prolapse. This would suggest a high rate of levator trauma, which is a strong predictor of such prolapse in the Western world. Hence, we decided to study the prevalence of maternal birth trauma in Nepali women.MethodsIn November 2016, we offered an interview, clinical examination, and 4‐dimensional translabial sonography to women attending a gynecology clinic. Of 129 women seen, 5 were excluded due to previous pelvic surgery. Translabial sonography volume data sets were obtained and analyzed by tomographic imaging for levator ani and anal sphincter trauma at a later date, blinded against all clinical data.ResultsMean age was 39 (21–74) years, median vaginal parity was 2 (0–9), mean age at first delivery 21 (14–40). Seventeen (14%) had not given birth vaginally; of these, 14 (11%) delivered by cesarean only, and 3 (2%) were nulliparous. Tomographic assessment for levator avulsion and anal sphincter trauma was possible in 124 women and performed as previously described. We found 2 (2%) unilateral avulsions and significant external anal sphincter defects in another 2 women.ConclusionsLevator and anal sphincter trauma are significantly less prevalent in Nepali women in comparison to Western populations. This is intriguing, especially in view of the high prevalence of prolapse in Nepali women.

Conclusions: Pelvic organ prolapse was very common in Nepali women attending a general gynecology clinic, confirming anecdotal data. This is especially true for uterine prolapse which was observed about 40%. Rectocele was comparatively uncommon. Patterns of pelvic organ prolapse in Nepal seem to be very different from patterns observed in Western populations. OP28.04The prevalence of major birth trauma in Nepali women Objectives: Prevalence of levator and sphincter trauma in Nepali women has not been studied in the past. The high prevalence of prolapse in Nepalese would suggest a high rate of avulsion which is a strong predictor of prolapse. Methods: In November 2016, the first and second author travelled to Nepal to offer an interview, clinical examination (POPQ) and 4D translabial ultrasound to women attending a Gynecology clinic. Of the 129 women seen, 16 (12%) presented with symptoms of pelvic floor dysfunction (urinary incontinence 3 (2%), obstructed defecation 3 (2%), prolapse 10 (8%)). Of these 129, 4 were excluded due to clerical error. The following results pertain to the remaining 125. Analysis of volume data sets was performed using proprietary software at a later date, blinded against all clinical data. Results: Mean age was 39 (21-74) years, mean BMI was 26 (17-39), median vaginal parity was 2 (0-9) and the mean age at first delivery was 21 (14-40). 17 (14%) were vaginally nulliparous; of these, 14 (11%) delivered by CS only and 3 (2%) were nulliparae. There were no vaginal operative births. When questioned, (37, 30%) complained of stress incontinence, 23 (18%) of urge incontinence and 25 (20%) of prolapse symptoms. A POPQ exam was possible in 124. Mean Gh was 4 (3-8), Pb was 3 (2-5), Gh+Pb mean 7 (5-12). Mean Oxford score was 3 (2-4). 4D ultrasound imaging was possible in 121 women. Tomographic assessment for avulsion and sphincter trauma was performed as previously described (figure). On post-processing, we found one complete and 13 (11%) partial avulsions. A significant EAS defect was diagnosed in 2 women (figure). Partial (minor) EAS trauma was detected in 14 (12%). Conclusions: Levator and anal sphincter trauma are significantly less prevalent in Nepali women as compared to western populations. This is intriguing, especially in view of the high prevalence of prolapse in Nepal.

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