The correlation between transperineal ultrasound assessment of the levator ani muscle and postpartum urinary incontinence

Abstract

Aims The primary aim of the present study was to assess the association between levator ani muscle (LAM) integrity and function on the one hand, and the risk of urinary incontinence (UI) on the other. A secondary objective was to assess the association between fundal pressure in the second stage of labor (Kristeller maneuver) and the risk of postpartum UI. Methods In this prospective cohort study, women underwent a clinical and transperineal ultrasound examination at rest, at pelvic floor muscle contraction (PFMC), and at Valsalva maneuver 3–6 months after their first vaginal delivery. LAM avulsion and levator hiatal area (LHA) were evaluated. In addition, women were interviewed about the presence of UI, whether stress (SUI) or urgency (UUI). Results Overall, data of 244 women were analyzed. SUI was reported in 50 (20.5%), while UUI was reported in 19 (7.8%) women. Women who reported SUI had a higher prevalence of LAM avulsion and less proportional reduction in LHA from rest to a maximum contraction in comparison to women with no SUI. Women who reported UUI had a greater LHA at rest, during contraction, and during maximal Valsalva in comparison to women without UUI. No significant association was found between the Kristeller maneuver and the incidence of any UI. Conclusion Levator ani avulsion and less proportional reduction of LHA with PFMC appear to be associated with a higher risk of postpartum urinary stress incontinence.

Authors’ Reply to “Comments on ‘Association Between Urinary Stress Incontinence and Levator Avulsion Detected by 3D Transperineal Ultrasound’”

“…Moreover, more than 60 % of women recruited for our study had episiotomy surgery during delivery, which means the incidence of levator avulsion was predictably high. This may be related to the fundamental realities in our country regarding the prevalence of episiotomy in the 1980 s to 1990 s. Most of the literature showed a prevalence of levator avulsion of greater than 20 % after the first delivery, e. g. 21.8 % in Symphorosa SC Chan group [13] and 27.5 %-35.2 % in Youssef A group [14]. This evidence means that the prevalence of levator avulsion in our study is reasonable.…”