As pregnancy progresses, women report poorer sexual function.
Introduction and hypothesis Consensus on normal translabial ultrasound (TL-US) anal sphincter complex measurements for postpartum women is lacking. We aimed to evaluate normative measurements in 2D and 3D TL-US for the anal sphincter complex (ASC) at 6 months postpartum and compare these measurements in women who had a vaginal birth (VB) and in those who had a Cesarean delivery (CD). Methods A large, prospective cohort of primiparous women underwent 2D and 3D TL-US 6 months after their first delivery. For normative sphincter measurements, we excluded women with third- or fourth-degree lacerations or with sphincter interruption on TL-US. Measurements included the sphincter thickness at the 3, 6, 9, and 12 o'clock positions of the external anal sphincter (EAS) and the internal anal sphincter (IAS) at proximal, mid, and distal levels. We also measured the mean coronal diameter of the pubovisceralis muscle (PVM). Results 696 women consented to participate, and 433 women presented for ultrasound imaging 6 months later. Women who sustained a third- or fourth-degree laceration had significantly thicker EAS measurements at 12 o'clock. Sphincter asymmetry was common (69 %), but was not related to mode of delivery. Only IAS measurements at the proximal and distal 12 o'clock position were significantly thicker for CD patients. There were no significant differences in the EAS or PVM measurements between VB and CD women. Conclusions There appear to be few differences in normative sphincter ultrasound measurements between primiparous patients who had VB or CD.
We describe the impact of genital trauma on pelvic floor function in a low-risk cohort of women after vaginal birth. Questionnaires (Present Pain Intensity Scale, Incontinence Impact Questionnaire, Fecal Incontinence Score, and Intimate Relationship Scale) were completed up to 12 weeks postpartum. Severity of trauma was recorded at delivery. Overall follow-up was 444/565 (79%). Major trauma (trauma that involved perineal muscles or required suturing) occurred in 20%; 20% delivered intact. At 12 weeks, 10% complained of perineal pain; 24% reported anal (AI) and 27% urinary incontinence (UI). Women with trauma were no more likely than those intact to complain of UI or AI, sexual inactivity, or perineal pain postpartum (all P=NS). Women with major trauma had weaker pelvic floor exercise strength than those who delivered intact or with minor trauma (odds ration 3.06, 95% confidence interval 1.41-6.63). Pelvic floor complaints postpartum were common but not associated with severity of genital trauma in a cohort of low-risk women.
BACKGROUND Perineal trauma after vaginal delivery can have significant long-term consequences. It is unknown if a larger infant head circumference (HC) or smaller maternal perineal anatomy are risk factors for perineal trauma after vaginal delivery. METHODS We conducted a prospective cohort study of low-risk nulliparous women. Data collected included maternal characteristics, antepartum POP-Q measurements of the perineal body and genital hiatus, labor characteristics, perineal trauma, and infant head circumference. Perineal trauma was defined as trauma that extended into the muscles of the perineum (second degree or deeper). Univariate and multivariate logistic models were created to calculate odd ratios (OR) and 95% confidence intervals (CI). RESULTS We observed 448 vaginal births. Multivariate analysis demonstrated a significant association between infant head circumference at birth and perineal trauma, OR 1.22 for each increase of 1cm in HC (95% CI 1.05-1.43). There was no association between perineal body or genital hiatus length and perineal trauma. CONCLUSIONS In nulliparous low-risk women a larger infant head circumference at birth increases the likelihood of perineal trauma, although the effect is modest. Antenatal perineal body and genital hiatus measurements do not predict perineal trauma. These results do not support alteration in mode of delivery or other obstetric practices.
Objective To explore the impact of body mass index BMI or pregnancy weight gain on the presence, site and severity of genital tract trauma at childbirth in nulliparous women. Methods The present study is a sub-analysis of a prospective cohort of healthy nulliparous women recruited during pregnancy and followed through birth. Weight gain during pregnancy and pre-pregnancy BMI were recorded. At birth, women underwent detailed mapping of genital tract trauma. For analyses, women were dichotomized into obese(BMI ≥30) versus non obese(BMI <30) at baseline as well as into those who gained weight as recommended by the Institute of Medicine (IOM) and those who gained more than the recommended amount to determine the impact of obesity or excessive weight gain on rates of genital tract trauma. Results Data from 445 women were available for analysis. Presence and severity of genital tract trauma did not vary between obese and non-obese women (P = NS). Likewise women who gained more than the IOM recommended weight did not have a higher incidence of perineal lacerations (53% vs 51% with perineal lacerations, P= .61). Obese women were more likely to gain in excess of the IOM guidelines during pregnancy (75% vs 50% excessive weight gain, obese vs non-obese women, P<0.001). Conclusion A woman’s BMI or excessive weight gain in pregnancy did not influence her risk of genital tract trauma at birth.
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