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Objectives To evaluate the learning process for acquiring three-and four-dimensional (3D/4D) transperineal ultrasound volumes of the levator hiatus (LH) dimensions (ICC,) for all LH measurements except the pubic arc (ICC = 0.67).

Objective To investigate associations between levator hiatus area and levator ani muscle function during pregnancy and major levator ani muscle defects postpartum.Design Observational prospective cohort study.Setting University hospital, Norway.Sample A cohort of 234 nulliparous women at 21 and 37 weeks of gestation, and at 6 weeks postpartum.Methods Ultrasound measurements of the levator hiatus at rest, during pelvic floor muscle contraction, and during the Valsalva manoeuvre were taken at 21 and 37 weeks of gestation. Levator ani muscle function was estimated as the percentage changes in levator ani muscle length from rest to contraction, and the level of muscle stretch during the Valsalva manoeuvre. Major levator ani muscle defects were diagnosed at 6 weeks postpartum using tomographic ultrasound imaging.Main outcome measures Associations between ultrasound measurements antepartum and major levator ani muscle defects postpartum.Results Women with major levator ani muscle defects postpartum had significantly smaller levator hiatus area at rest and during the Valsalva manoeuvre at mid-pregnancy (mean difference 1.03 cm 2 , 95% CI 0.31-1.76; 2.92 cm 2 , 95% CI 1.77-4.07), and at 37 weeks of gestation (mean difference 1.47 cm 2 , 95% CI 0.62-2.32; 2.84 cm 2 , 95% CI 0.88-4.80), than women without such defects.They also had significantly less shortening of the levator ani muscle during contraction at 37 weeks of gestation.Conclusions Smaller levator hiatus area at rest and during the Valsalva manoeuvre at mid and late pregnancy, and less shortening of the levator ani muscle during contraction at 37 weeks of gestation, are associated with major levator ani muscle defects postpartum.Keywords Levator hiatus, major levator ani muscle defects, pregnancy, transperineal ultrasound.Please cite this paper as: Siafarikas F, Staer-Jensen J, Hilde G, Bø K, Ellström Engh M. The levator ani muscle during pregnancy and major levator ani muscle defects diagnosed postpartum: a three-and four-dimensional transperineal ultrasound study.

Summary Objective To describe changes in pelvic organ support from mid pregnancy until 1 year postpartum among nulliparous pregnant women, and to examine whether delivery route affects changes in pelvic organ support.Design Prospective cohort study. Setting Akershus University Hospital in Norway.Population A cohort of 300 nulliparous pregnant women included at mid-pregnancy.Methods Pelvic organ support assessed at 21 and 37 weeks of gestation, and again at 6 weeks, 6 months, and 12 months postpartum, by the use of the Pelvic Organ Prolapse Quantification (POP-Q) system. Linear mixed model was used to assess longitudinal change in pelvic organ support.Main outcome measures Prevalence of anatomic POP. Change in POP-Q variables over time and between delivery groups.Results The prevalence of anatomic POP ranged from 0 to 10%. Vaginal POP-Q points made a cranial shift from mid to late pregnancy, a caudal shift following delivery, and again a cranial shift after 6 weeks postpartum. Postpartum change was present following both vaginal and caesarean deliveries, but was more pronounced following vaginal delivery. The perineal body and genital hiatus became longer from mid to late pregnancy, and shortened after 6 weeks postpartum. At 12 months postpartum all POP-Q points, except cervix, had recovered to baseline in the vaginal delivery group.Conclusions The prevalence of anatomic POP was low in this cohort. There was change in pelvic organ support both during pregnancy and following vaginal as well as caesarean delivery. The short-term ability to recover was good after the first pregnancy and delivery.Keywords Delivery, pelvic organ support, POP, postpartum, pregnancy, primipara.Tweetable Abstract Pelvic organ support changes during pregnancy. A contribution to the risk of POP?

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