MR Imaging of Levator Ani Muscle Recovery Following Vaginal Delivery

Tunn, Ralf; DeLancey, John O.L.; Howard, Denise; Thorp, John M.; Ashton‐Miller, James A.; Quint, Leslie E.

doi:10.1007/s001929970006

Cited by 123 publications

(75 citation statements)

References 18 publications

(15 reference statements)

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“…17,18 The ability of MRI to allow study of the entire muscle in both two-dimensional and threedimensional displays in living women has obvious advantages for scientific study. 2,19,20 It also allows the ethical study of normal volunteers with proven continence and pelvic organ support. With the significant asymmetries of muscle damage seen, MRI avoids the problems stemming from taking a single biopsy from one side of an individual, which might indicate a healthy muscle there but would fail to pick up that the muscle on the other side is abnormal.…”

Section: Discussionmentioning

confidence: 99%

The appearance of levator ani muscle abnormalities in magnetic resonance images after vaginal delivery

DeLancey

Kearney

Chou

et al. 2003

Obstetrics & Gynecology

390

203

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OBJECTIVE-To describe the appearance and occurrence of abnormalities in the levator ani muscle seen on magnetic resonance imaging (MRI) in nulliparous women and in women after their first vaginal birth.METHODS-Multiplanar proton density magnetic resonance images were obtained at 0.5-cm intervals from 80 nulliparous and 160 vaginally primiparous women. These had been previously obtained in a study of stress incontinence, and half the primiparas had stress incontinence. All scans were reviewed independently by at least two examiners blinded to parity and continence status. RESULTS-Nolevator ani defects were identified in nulliparous women. Thirty-two primiparous women (20%) had a visible defect in the levator ani muscle. Defects were identified in the pubovisceral portion of the levator ani in 29 women and in the iliococcygeal portion in three women. Within the pubovisceral muscle, both unilateral and bilateral defects were found. The extent of abnormality varied from one individual to the next. Of the 32 women with defects, 23 (71%) were in the stress incontinent group.CONCLUSION-Abnormalities in the levator ani muscle are present on MRI after a vaginal delivery but are not found in nulliparas.During a study of the role of vaginal birth in causing urinary incontinence we obtained magnetic resonance images of women with stress incontinence after their first vaginal birth and of normal continent nulliparous and primiparous controls. On evaluating these scans we found abnormalities in the levator ani muscles in both the continent and incontinent women. The abnormalities seemed to occur only in women who delivered vaginally, and not in nulliparas. These abnormalities involved both the pubovisceral and iliococcygeal portions of the muscle and were sometimes unilateral and sometimes bilateral. Here we describe these defects and evaluate whether or not they are associated with vaginal delivery. MATERIALS AND METHODSMagnetic resonance images of the pelvis were obtained from 240 women as part of an institutional review board-approved study concerning vaginal delivery and stress urinary incontinence. Multiplanar two-dimensional fast spin (echo time 15 ms, repetition time 4000 ms) proton density magnetic resonance images of all pelves were obtained by use of a 1.5-tesla superconducting magnet (Signa; General Electric Medical Systems, Milwaukee, WI) with version 5.4 software as previously described. 1 Images 5 mm apart were obtained in axial, coronal, and sagittal views.

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Section: Discussionmentioning

confidence: 99%

The appearance of levator ani muscle abnormalities in magnetic resonance images after vaginal delivery

DeLancey

Kearney

Chou

et al. 2003

Obstetrics & Gynecology

390

203

View full text Add to dashboard Cite

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“…Muscular distension, ischemia and neurologic traumas are all possible mechanisms that may play a role in the trauma that the pelvic musculature undergoes during vaginal delivery, in particular affecting the levator ani. Immediately after delivery, we witness a functional deficit of this muscle, followed by spontaneous recovery approximately 6 months later [13]. This slow recovery reflects the time needed to recover from the different types of lesions: while the intracellular disruption of sarcomeres only takes a few weeks to repair, neurological damage may require several months.…”

Section: Discussionmentioning

confidence: 99%

Perineal ultrasound evaluation of the urethrovesical junction angle and urethral mobility in nulliparous women and women following vaginal delivery

et al. 2005

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The objective of this study was to demonstrate the differences in the urethrovesical junction angle and urethral mobility by means of perineal ultrasounds in women following vaginal delivery with respect to nulliparous women. We have enrolled 34 women, 12 nulliparous (Group A) and 22 women in the post-partum period (Group B). The ultrasounds were employed to measure the urethrovesical junction angle ("urethro-pelvic" angle) and the urethral mobility. Data obtained show that the urethro-pelvic angle is narrower in Group A (97.3 degrees) with respect to Group B (112.5 degrees). Urethral mobility while coughing was significantly higher in Group B (30.4 degrees) with respect to Group A (-2 degrees). This study demonstrates the difference in the urethral support at rest and during cough in nulliparous versus recently delivered parous women.

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“…When the examination was performed shortly after delivery [14,16] it is likely that the recovery of pelvic floor structures had not yet been completed. We choose 6 months for evaluation because recovery of connective tissue and complete pelvic floor muscles contractility is known to take up to 6 months [23]. …”

Section: Discussionmentioning

confidence: 99%

Influence of Mode of Delivery on Pelvic Organ Support 6 Months Postpartum

Diez-Itza¹,

Arrue²,

Ibañez³

et al. 2011

Gynecol Obstet Invest

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Aims: The aims of this study were to describe pelvic organ support 6 months postpartum among women who delivered by cesarean section, spontaneous and instrumental vaginal delivery, and to evaluate the differences between the groups. Methods: This was a cross-sectional study of 382 primigravid women who gave birth at Donostia Hospital during 2007. Pelvic organ support was explored 6 months postpartum using the pelvic organ prolapse quantification (POPQ) system. Joint hypermobility, height and weight were also assessed. Results: POPQ stage ≧II was present in 7.7, 18.1 and 29.0% of women who delivered by cesarean section, spontaneous and instrumental vaginal delivery, respectively. Spontaneous vaginal delivery increased the risk by more than three times (OR 3.19; 95% CI 1.07–9.49) while instrumental vaginal delivery increased it more than fivefold (OR 5.52; 95% CI 1.79–17.30) in comparison with cesarean section. Instrument-assisted delivery did not increase the risk of prolapse in women who delivered vaginally. Conclusions: Cesarean section is associated with a lower prevalence of pelvic organ prolapse after delivery. Instrument- assisted delivery is not associated with an increased risk of postpartum prolapse among women who delivered vaginally.

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MR Imaging of Levator Ani Muscle Recovery Following Vaginal Delivery

Cited by 123 publications

References 18 publications

The appearance of levator ani muscle abnormalities in magnetic resonance images after vaginal delivery

The appearance of levator ani muscle abnormalities in magnetic resonance images after vaginal delivery

Perineal ultrasound evaluation of the urethrovesical junction angle and urethral mobility in nulliparous women and women following vaginal delivery

Influence of Mode of Delivery on Pelvic Organ Support 6 Months Postpartum

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