Assessment of pelvic floor by three-dimensional-ultrasound in primiparous women according to delivery mode: initial experience from a single reference service in Brazil

Abstract

Assessment of pelvic floor by threedimensional-ultrasound in primiparous women according to delivery mode: initial experience from a single reference service in Brazil Abstract PURPOSE: To evaluate changes to the pelvic floor of primiparous women with different delivery modes, using three-dimensional ultrasound. METHODS: A prospective cross-sectional study on 35 primiparae divided into groups according to the delivery mode: elective cesarean delivery (n=10), vaginal delivery (n=16), and forceps delivery (n=9). Three-dimensional ultrasound on the pelvic floor was performed on the second postpartum day with the patient in a resting position. A convex volumetric transducer (RAB4-8L) was used, in contact with the large labia, with the patient in the gynecological position. Biometric measurements of the urogenital hiatus were taken in the axial plane on images in the rendering mode, in order to assess the area, anteroposterior and transverse diameters, average thickness, and avulsion of the levator ani muscle. Differences between groups were evaluated by determining the mean differences and their respective 95% confidence intervals. The proportions of levator ani muscle avulsion were compared between elective cesarean section and vaginal birth using Fisher's exact test. RESULTS: The mean areas of the urogenital hiatus in the cases of vaginal and forceps deliveries were 17.0 and 20.1 cm 2 , respectively, versus 12.4 cm 2 in the Control Group (elective cesarean). Avulsion of the levator ani muscle was observed in women who underwent vaginal delivery (3/25), however there was no statistically significant difference between cesarean section and vaginal delivery groups (p=0.5). CONCLUSION: Transperineal three-dimensional ultrasound was useful for assessing the pelvic floor of primiparous women, by allowing pelvic morphological changes to be differentiated according to the delivery mode. ResumoOBJETIVO: Avaliar as mudanças no assoalho pélvico de mulheres primíparas em diversos tipos de partos por meio da ultrassonografia tridimensional. MÉTODOS: Estudo de corte transversal prospectivo com 35 primigestas, divididas em grupos com relação ao tipo de parto: cesariana eletiva (n=10), parto vaginal (n=16) e fórceps (n=9). A ultrassonografia tridimensional do assoalho pélvico foi realizada no segundo dia pós-parto com a paciente em repouso. Utilizou-se transdutor convexo volumétrico (RAB4-8L) em contato com os grandes lábios vaginais, estando a paciente em posição ginecológica. Medidas biométricas do hiato urogenital foram tomadas no plano axial da imagem renderizada para avaliar a área, os diâmetros anteroposterior e transverso, a espessura média e a avulsão do músculo elevador do ânus. Diferenças entre os grupos foram avaliadas pela determinação da média das diferenças com seus respectivos intervalos de confiança de 95%. As proporções de avulsão do músculo elevador do ânus foram comparadas entre a cesárea eletiva e o parto vaginal pelo teste exato de Fisher. RESULTADOS: As áreas médias do hiato urogenital dos partos vaginais e ...

Levator ani avulsion: a Systematic evidence review (LASER)

“…This was based on 12 studies reporting on a total of 1783 births (Figure 3, Figure S3). 9,21,24,29,31,32,34,39,41,46,47,52 Whereas that following forceps versus spontaneous delivery was 6.32 (4.56–8.76, I 2 = 0%) (Figure 3, Figure S4) as assessed by ten studies involving 1372 women 9,21,24,28,29,31,33,41,51,52 . For this analysis we did not include the study by Thibault‐Gagnon et al 39 .…”

“…For this analysis, only studies that reported on the two compared modalities were included. A total of 12 studies involving 1570 women reported on LA following spontaneous delivery and CS at first birth 9,21,24,28,31–33,39,41,44,51,53 . The calculated odds ratio for having an LA following a spontaneous delivery compared with CS was 10.69 (5.44–21.0, I 2 = 0%) (Figure 3, Figure S2).…”

“…A total of 23 studies involving 1207 women who were only delivered by CS contributed data for this outcome 9,13,21–25,27,28,31–33,35,39–44,49,51,53,54 . All the studies reported no LAs with the exception of Araujo et al., 43 Guedea et al 32 .…”

Assessment of Pelvic Floor Disorders due to the Gestational Diabetes Mellitus Using Three-Dimensional Ultrasonography: A Narrative Review

“…Independently of the mode of delivery, the UI incidence was higher in the larger HA group. 33 A study conducted in Brazil, in 2013, by Araujo Júnior et al 34 at Universidade Federal de São Paulo evaluated the changes in the 3DUS of the PF of primiparous women with different delivery modes. They demonstrated higher HA in the postpartum vaginal group and forceps about cesarean delivery.…”

“…They demonstrated higher HA in the postpartum vaginal group and forceps about cesarean delivery. 34 Chan et al, in 2013, 35 investigated PF biometrics during pregnancy and its correlation with symptoms of PF disorders in each trimester of pregnancy. The HA significantly increased by 15.1 þ/-24.8% at rest and 24.7 þ/-28.5% at Valsalva from the first to the third trimester.…”