Background: Pelvic floor muscles (PFM) and rectus abdominis muscles (RAM) of pregnant diabetic rats exhibit atrophy, co-localization of fast and slow fibers and an increased collagen type I/III ratio. However, the role of similar PFM or RAM hyperglycemic-related myopathy in women with gestational diabetes mellitus (GDM) remains poorly investigated. This study aims to assess the frequency of pelvic floor muscle disorders and pregnancy-specific urinary incontinence (PS-UI) 12 months after the Cesarean (C) section in women with GDM. Specifically, differences in PFM/ RAM hyperglycemic myopathy will be evaluated. Methods: The Diamater is an ongoing cohort study of four groups of 59 pregnant women each from the Perinatal Diabetes Research Centre (PDRC), Botucatu Medical School (FMB)-UNESP (São Paulo State University), Brazil. Diagnosis of GDM and PS-UI will be made at 24-26 weeks, with a follow-up at 34-38 weeks of gestation. Inclusion in the study will occur at the time of C-section, and patients will be followed at 24-48 h, 6 weeks and 6 and 12 months postpartum. Study groups will be classified as (1) GDM plus PS-UI; (2) GDM without PS-UI; (3) Non-GDM plus PS-UI; and (4) Non-GDM without PS-UI. We will analyze relationships between GDM, PS-UI and hyperglycemic myopathy at 12 months after C-section. The mediator variables to be evaluated include digital palpation, vaginal squeeze pressure, 3D pelvic floor ultrasound, and 3D RAM ultrasound. RAM samples obtained during C-section will be analyzed for ex-vivo contractility, morphological, molecular and OMICS profiles to further characterize the hyperglycemic myopathy. Additional variables to be evaluated include maternal age, socioeconomic status, educational level, ethnicity, body mass index, weight gain during pregnancy, quality of glycemic control and insulin therapy. Discussion: To our knowledge, this will be the first study to provide data on the prevalence of PS-UI and RAM and PFM physical and biomolecular muscle profiles after C-section in mothers with GDM. The longitudinal design allows for the assessment of cause-effect relationships between GDM, PS-UI, and PFMs and RAMs myopathy. The findings may reveal previously undetermined consequences of GDM.
score 6 (0-20), and median post-operative clinical POPQ stage 1 (0-2). On ultrasound, clear visualization was obtained in all patients. 8 patients had avulsion defects (75%, 5 bilateral) and all had ballooning on Valsalva. There was no correlation between clinical POPQ staging and ultrasound parameters of prolapse, levator hiatal dimensions or the presence of avulsion defects. Two women were found to have a urethral diverticulum on ultrasound, which was neither symptomatic nor clinically apparent. Conclusions: 4D transperineal ultrasound is an effective tool in the evaluation of vaginal anatomical and functional changes following colpocleisis. It can acquire data that may elude the clinician in view of the obliterative nature of the operation. Future study is warranted to investigate the association between ultrasound findings and patients' subjective symptoms in a larger cohort. P32.05Area of pubovisceral muscle and levator hiatus by 3D translabial ultrasound in runner women: preliminary results Z. Di Bella, E. Araujo Junior, M. Zanetti, L. Nardozza, A. F. Moron Universidade Federal de Sao Paulo, Sao Paulo, BrazilObjectives: To analyze the area of the pubovisceral muscle and the levator hiatus by 3D ultrasound in runner women. Methods: Observational study, with 24 consecutively included runners women. Inclusion criteria was the ability to do a correct pelvic floor muscle contraction and women should run from 15 km to 60 km a week. Exclusion criteria were women with pathologies that could interfere on the pelvic floor contraction such as neuromuscular degeneration, and previous urogynaecology surgery. The exams were realized by 3D translabial ultrasound using convex transductor oriented in the mid-sagittal plane. Volumes were acquired twice at rest, during Valsalva maneuver and during maximal voluntary contraction (MVC). The plane of minimal hiatal dimensions is identified in the mid-sagittal plane, considered as the minimal distance between the posterior aspect of the symphysis pubis and the anterior border of the pubovisceral muscle, just posterior to the anorectal muscularis. The area of the pubovisceral muscle was defined by tracing this muscle outline. To compare the mean of area of the pubovisceral muscle and the levator hiatus in rest, Valsalva and MVC was used the Friedman test Results: The mean of levator hiatus area was 13.7, 17.6 and 10.3 cm 2 in rest, Valsalva and MVC, respectively (P < 0.001). The mean of pubovisceral muscle area was 11.2, 11.1 and 10.6 cm 2 in rest, Valsalva and MVC, respectively (P = 0.59). Conclusions: These preliminary results demonstrate statistically significant differences in the area of the levator hiatus but not in the area of pubovisceral muscle at rest, Valsalva and MVC in runner women by 3D translabial ultrasound. Objectives: To assess interrater reliability of vaginal masses evaluated by 3D endovaginal ultrasonography. Methods: 37 3D data cubes from 4 institutions were reviewed by two reviewers and interrater reliability was established. For comparison of clinical and u...
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