Objectives:In 10-30% of women, vaginal birth results in levator ani tears which are associated with female pelvic organ prolapse and reduced contraction strength in later life. This study was undertaken to determine whether women notice such changes after childbirth. Methods: This is a retrospective analysis of two perinatal imaging studies. Patients were followed up 3-6 months postpartum. They were asked to estimate pelvic floor strength relative to strength just before childbirth, using a percentage. Translabial 4D pelvic floor ultrasound was performed to determine structure and function of the levator ani muscle. Imaging analysis was performed offline, using proprietary software, blinded against all clinical data. Levator avulsion was diagnosed on tomographic imaging in the axial plane. Results: 513 primiparous women were seen for follow-up in the context of two prospective trials, at a median of 129 days postpartum. They had given birth to a singleton at a mean gestation of 40.0 (range, 36+0 to 42+5). There were 351 vaginal deliveries (27 Forceps, 60 Vacuum and 264 NVD) and 162 Caesareans (31.6%). At follow-up, 482 were able to rate their pelvic floor strength relative to the situation prior to childbirth, reporting an average strength of 89%. This reduction was associated with delivery mode (P < 0.001), length of 2 nd stage (P = 0.017) and episiotomy (P = 0.019). 45 women were diagnosed with levator avulsion which was associated with a greater reduction (no avulsion, 90% vs., unilateral avulsion, 86%, bilateral avulsion 80%, P= 0.007 on ANOVA). Conclusions: Many women notice altered pelvic floor function after childbirth. Vaginal childbirth, episiotomy, perineal tears and length of 2 nd stage are associated with subjectively reduced pelvic floor strength after first delivery. Women who have suffered a levator avulsion notice a significantly greater reduction in subjective strength. OC29.03 Does levator trauma 'heal'?K. Shek, V. Wong, S. E. Langer, H. Dietz Department of Ob/Gyn, Sydney Medical School Nepean, Penrith, NSW, AustraliaObjectives: To compare levator ani morphology, hiatal area and pelvic organ support 4 months and 2 years after first delivery. Methods: 488 nulliparous women originally recruited and assessed at 36-38 weeks' gestation were invited for a 4D translabial ultrasound at 3-6 months and 2-3 years after childbirth. Results: 367 and 161 participants returned for assessment at 4.1 months (IQR 3.7-5) and 2.6 years (IQR 2.0-3.1) respectively. No change in bladder neck descent (BND) and hiatal area on Valsalva was noted. Analysis of participants with no further births (n = 77) and of women who had delivered vaginally (n = 53) revealed similar findings except a significant reduction in BND (31.2 vs. 28.3 mm, P = 0.025) in the latter group. At 3-6 months, 12 women were diagnosed with avulsion. At 2-3 years 3 of those were considered normal. Their volumes were reviewed. In one case the original diagnosis was likely false positive. The other two showed clear signs of improvement in appearances on t...
Oral communication abstractsConclusions: VWT anteriorly and posteriorly is lower in women with vaginal prolapse until the prolapse extends beyond the introitus and then VWT is thicker and comparable with women without prolapse.Supporting information can be found in the online version of this abstract. Objective: Several mechanisms are believed to be in play maintaining anal continence, one of them being voluntary squeezing using the pelvic muscles. Here we study the effect of squeeze on the anal channel position and dimensions. Method: 20 healthy 0-gravida and 24 women with anal incontinence were recruited after written consent for 3D vaginal ultrasound measurements of angles and diameters during rest and squeeze. The anovaginal angle was defined as the angle between the posterior vaginal wall and the anterior wall of the channel assessed in a sagittal section. The anorectal angle was defined as the angle between the posterior wall of the anal channel and that of the rectal wall above the level of the puborectal muscle. Diameter and area of the mucosa were measured in the middle of the anal channel (lower level) and at the level of the puborectal muscle (upper level). Results: The 0-gravida had a mean age of 26 years with an incontinence score 0 on a scale 0-24. The incontinent women had a mean age of 59 years and their score was mean 11 (range 3-22). The ultrasound measurement results are presented in the table. Conclusion: Voluntary squeeze augments the bend of the anal and rectal tube at the level of the puborectal muscle and compresses the mucosal cuff at this level in young 0-gravida women. In incontinent women of a higher age, the anal tube is straighter, the mucosal cuff in the lower anal channel is smaller, and the effect of squeeze is less prominent or lacking. OC30.02 OC30.03The impact of first delivery on the levator hiatus and the urogenital hiatus
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