Magnetic resonance imaging of the pelvic floor in the postpartum patient

Abstract

Magnetic resonance imaging (MRI) was used to assess anatomical changes in the pelvic floor after childbirth. Six women underwent serial MRI examination within 30 hours and at 1 week, 2 weeks, 6 weeks and 6 months after delivery; 8 additional women were studied only within 30 hours of delivery. T-1 and T-2-weighted images of the pelvis in the transverse and sagittal planes with a 1.5-T MR imager were obtained. In the sagittal section we assessed the urethrovesical angle, urethral length, distance from the symphysis to the proximal and distal vagina, vaginal length, width and length of the sphincters, and the presence of sphincter defects. Axial sections were assessed for sphincter defects for the distance between the symphysis and midurethra, vagina and rectum. Only one parameter (distance between symphysis and distal vagina) changed significantly over time, without a clear trend in direction. Interobserver variation was reasonable (<15%) except for anal canal length, urethral length and distance between symphysis and anus. There were no significant correlations between birthweight and MRI parameters. There was a non-significant association (P = 0.09) between the sole combined sphincter defect and rectal injury, but not with episiotomy or parity. We concluded that it is feasible to determine multiple measurements on MR images to evaluate structures of the pelvic floor.

Pelvic structure and function at 1 month compared to 7 months by dynamic magnetic resonance after vaginal birth

“…In addition, our findings extend the current literature by adding information about location and movement during Valsalva and Kegel maneuvers. Hayat et al studied the urethrovesical angle, urethral length, distance from the symphysis to the proximal and distal vagina, vaginal length, and width and length of the sphincters in MR images of pregnant women at several time points between 1 week to 6 weeks postpartum 10. They found that the distance between symphysis and distal vagina changed significantly over time but without a clear trend in direction (p = 0.01).…”

“…Studies have evaluated pelvic floor locations and dimensions of different pelvic floor structures in parous women using MR imaging in the postpartum period to evaluate static resting position,10,11 using MR imaging during straining to compare parous to nulliparous women,12 or using ultrasounds before and after deliveries 13. However, these studies are limited by their cross-sectional design, short postpartum follow-up time, and/or not evaluating dynamic properties with both Kegel and Valsalva maneuvers.…”

Longitudinal comparison study of pelvic floor function between women with and without stress urinary incontinence after vaginal delivery

“…The contractile function gradually gets weaker during pregnancy and remains significantly weaker at 6 months after vaginal delivery as compared with before delivery [9]. The supporting function also decreases during pregnancy and vaginal delivery and slowly recovers in the postpartum period [12][13][14]. According to a cross-sectional study of the etiology of stress urinary incontinence in the postpartum period, women with stress urinary incontinence have a weaker supporting function of the pelvic floor than continent women at about 3 months after delivery [15].…”

MR Imaging of Levator Ani Muscle Recovery Following Vaginal Delivery

“…We reviewed serial MR images originally obtained to study involution of the uterus [5] after vaginal delivery and postpartum changes in pelvic organ positions [6]. It became evident from these images that significant and potentially important changes were visible in the LA during the first 6 months after delivery.…”