Post-partum pelvic floor dysfunction assessed on 3D rotational ultrasound: a prospective study on women with first- and second-degree perineal tears and episiotomy

Abstract

Purpose: To evaluate the morphology and biometry of pelvic floor structures 3 months after birth in women experiencing first-or second-degree perineal tears or undergoing episiotomy during labor. Material and methods: Prospective observational study including nulliparous women delivering at term with a clinical diagnosis of first-or second-degree perineal tears after birth or undergoing episiotomy. The role of Kristeller maneuver during labor in affecting pelvic structure and function is also explored. All women underwent 2D trans-perineal and 3D endovaginal or endoanal ultrasound 3 months after birth. Results: 115 women assessed 3 months after delivery were enrolled in the study. Compared with controls, women who experienced first-degree perineal tears had higher bladder neck-symphysis (versus 20.9 ± 4.9 versus 16.1 ± 4.9 mm, p ¼ .017), bladder wall-pubic symphysis (22.4 ± 7.4 versus 14.2 ± 9.5 mm, p ¼ .02) and anorectal angle-symphysis distance (12.5 ± 4.7 versus 9.3 ± 4.3 mm, p ¼ .018). Furthermore, they have thicker internal and external anal sphincter. The incidence of partial right and left pubo-rectalis muscle avulsion was higher in women experiencing first-degree vaginal tear during labor (16.2 versus 0%, p ¼ .004 for both). In women affected by second-degree tears, the occurrence of partial avulsion of the right and left pubo-rectalis muscle was 16.2%, while Oasis was detected in 10.8% of the cases. Women receiving Kristeller maneuver during labor had a higher incidence of either right or left puborectalis muscle avulsion. Conclusion: Women who had either first-and second-degree perineal tears or episiotomy show signs of abnormal pelvic morphometry on 3D rotational ultrasound 3 months after birth.

Detailed classification of second‐degree perineal tears in the delivery ward: an inter‐rater agreement study

“…The rates of sphincter tears in the study period was 0.8%–1.3%, which is comparable to the sphincter tear rates in our institution within the last year (1.3%) as well as to national numbers 27 . However, in previous studies, higher rates of sphincter tears were found when a trained assessor re‐examined the perineum or an ultrasound examination of the woman's perineum was performed after delivery 11,28,29 . Nevertheless, current practice does not recommend an ultrasound examination as a routine assessment of the perineum immediately after delivery 30 .…”

Systematic review and meta-analysis of evaluation of selective cesarean section in postpartum pelvic floor function recovery under perineal ultrasound

“…It also increases the incidence of postoperative complications such as incision infection, scar pregnancy, pelvic adhesions, endometriosis, and chronic pelvic pain (32,33). At present, trans-perineal pelvic floor ultrasound has obvious advantages in clinical diagnosis and efficacy evaluation of female pelvic floor dysfunction, so it has become the preferred method to evaluate the pelvic floor structure and function of patients (34).…”

Diagnostic Value of Combined Detection of Pelvic Ultrasound and Serum LH, FSH, and E2 Levels in Children with Idiopathic Central Precocious Puberty

“…According to the pathogenesis, it can be divided into central precocious puberty, peripheral precocious puberty, and incomplete or partial precocious puberty [1][2][3]. Idiopathic central precocious puberty (ICPP) is caused by declined sensitivity of hypothalamus to negative feedback of sex hormones and premature increase in the secretion and release of gonadotropin-releasing hormone, which a ict more girls than boys in clinical practice [4,5]. Previous studies have shown that adolescent growth rate peaks ahead will lead to early closure of bone age and bone scale, resulting in short stature and poor physical coordination and posing negative impact on the physical and mental health of patients [6,7].…”