Early postpartum pelvic floor changes in primiparous women after vaginal delivery using 3T MRI

Abstract

AIMS Detection of early morphological pelvic floor changes after vaginal delivery in primiparous women using 3 Tesla magnetic resonance imaging. METHODS A 3 Tesla magnetic resonance imaging was performed using static T2‐weighted turbo spin echo (tse) in three planes, T2‐weighted tse fat saturated and T1‐weighted sequence in transverse plane. All visible changes of pelvic structures (edema, hematoma, tear, or avulsion) were documented. Measurements for the integrity of the pelvic floor were performed and compared to a nulliparous control‐group. Differences in pelvic floor parameters were analyzed using an unpaired t‐test. P<0.05 was considered statistically significant. RESULTS Twenty‐five primiparous women delivered vaginally at term and underwent postpartum magnetic resonance imaging. Several morphological changes in the pelvis, superficial as well as deep, were detected in all participants. Anteroposterior hiatus, hiatal circumference, hiatal area, laterolateral hiatus, maximum muscle thickness, and levator urethra gap were significantly different to the nulliparous control‐group. CONCLUSIONS Two‐dimensional 3 Tesla magnetic resonance imaging is feasible in a clinical and early postpartum setting establishing a reliable diagnostic tool to evaluate numerous morphological pelvic floor changes and the integrity of the pelvic floor.

MRI comparative study of levator ani muscle changes in nulliparous and multiparous females

“…They also emphasized the importance of postpartum MRI examination to rule out associated iliococcygeus muscle injuries or thinning that can be missed by ultrasound examination. These results also agreed with Alt et al [18] detecting numerous superficial and deep pelvic morphological changes between nulliparous and primiparous female (P < 0.001).…”

Pelvimetry in nulliparous and primiparous women using 3 Tesla magnetic resonance imaging

“…The levator ani muscle and its extension were identified and shown to be fully intact in all 25 nulliparous women, whereas five different types of injury directly concerning the pubovisceral muscle (PVM) were assessed by MR imaging in the primiparous group (Supplement Table S1) . Comparing these PVM injury types with the pelvimetric dimensions obtained here revealed a significant correlation between five injury types (left‐sided pubovisceral muscle avulsion and the ITD ( P < 0.045) and the OC ( P < 0.002), left‐sided PVM tear, and the ISD ( P < 0.005), PVM hematoma, and the CCL ( P < 0.047), and right‐sided PVM edema at the insertion to the pubic bone and the OC ( P < 0.033); (Supplement Table S1, Figure ).…”

“…All primiparous women in the study cohort delivered vaginally at term and underwent pelvic 3T MRI (Tim Trio, Siemens, Erlangen, Germany) within 1 week postpartum. LAM injuries in the primiparous study group had been diagnosed and discussed previously . Potential consistencies between pelvimetric measurements and previous LAM lesions in this group were documented.…”

“…Two‐dimensional MR images from a prospective cross‐sectional study on the morphological changes after a first vaginal delivery were evaluated for pelvimetric measurements. This study protocol and trial were approved by the local ethics committee and designed in accordance of the Declaration of Helsinki . The inclusion criteria were primiparous women ≥18 years of age who had delivered vaginally at term in the Department of Obstetrics and Gynecology of the University of Heidelberg Medical School, Germany and written, informed consent to participate in this trial.…”

“…The LAM represents an important part of the female pelvic floor because it supports the pelvic organs and provides a passage for the urethra, vagina, and rectum . Several studies using transperineal ultrasound or magnetic resonance imaging (MRI) have shown that VCB has a severe impact on the LAM complex . The most well‐known measurements for the integrity of the pelvic floor are based mainly on soft tissue reference points, but to detect and learn more about cephalopelvic disproportions, established measurements of the bony pelvis can be considered .…”