Three-dimensional Ultrasound Appearance of Pelvic Floor in Nulliparous Women and Postpartum Women One Week after Their First Delivery

Abstract

This study investigated the morphology and structure of pelvic floor in 50 nulliparous and 95 postpartum women (47 vaginal delivery, 48 Cesarean section) using translabial three-dimensional (3D) ultrasound. All the primiparae underwent ultrasound examination within one week after their first delivery. Volume datasets were acquired and analyzed to determine the alterations of levator hiatus after childbirth. Significant differences were observed in the levator hiatus of postpartum women compared with that of nullipara women. In postpartum women, the levator hiatus, with their dimensions increased, expanded into a circular shape. Puborectalis was avulsed in eight cases (accounting for 8.42% of all) and pelvic organ prolapse was found in 12 cases (accounting for 12.63%). The hiatal dimensions were larger and the incidence of pubrectalis muscle avulsion (17.02% vs. 0%) and pelvic organ prolapse (21.28% vs. 4.17%) was significantly higher in Vaginal delivery group than Cesarean section group. In summary, 3D ultrasound is an effective tool to detect the pelvic floor of postpartum women who present with morphological abnormalities, and such abnormalities are more likely to show in vaginal delivery women compared to Cesarean section.

Levator ani avulsion: a Systematic evidence review (LASER)

“…A total of 23 studies involving 1207 women who were only delivered by CS contributed data for this outcome 9,13,21–25,27,28,31–33,35,39–44,49,51,53,54 . All the studies reported no LAs with the exception of Araujo et al., 43 Guedea et al 32 .…”

“…For this analysis, only studies that reported on the two compared modalities were included. A total of 12 studies involving 1570 women reported on LA following spontaneous delivery and CS at first birth 9,21,24,28,31–33,39,41,44,51,53 . The calculated odds ratio for having an LA following a spontaneous delivery compared with CS was 10.69 (5.44–21.0, I 2 = 0%) (Figure 3, Figure S2).…”

“…A total of 23 studies involving 1207 women who were only delivered by CS contributed data for this outcome. 9,13,[21][22][23][24][25]27,28,[31][32][33]35,[39][40][41][42][43][44]49,51,53,54 All the studies reported no LAs with the exception of Araujo et al, 43 Guedea et al 32 and Aydin et al, 35 who reported LA incidence rates of 14, 5 and 40%, respectively. A meta-analysis of all 23 studies showed an overall incidence rate of 0.03 (3%) (0.00-0.05, I 2 = 66%).…”

“…We identified 23 studies involving a total of 2152 women that assessed LA following the first spontaneous vaginal birth. 9,21,24,28,29,[31][32][33][34]37,39,41,[43][44][45][46][47][48][50][51][52][53]55 The pooled incidence rate of LA in these studies was 0.16 (16%) (0.13-0.19, I 2 = 73%). The highest incidence rate of LA of 0.58 (58%) was reported by Araujo et al, 43 which was much higher than the rates reported by other studies.…”

Longitudinal Study of Pelvic Floor Characteristics Before, During, and After Pregnancy in Nulliparous Women

“…Studies investigating the changes of the pelvic floor during pregnancy showed that these changes already occur in the course of pregnancy. Most studies started their analysis in pregnancy and compared pelvic floor measurements between mid and late pregnancy and after delivery 8,13–20 . No study published till date has characterized the pelvic floor before, during, and after pregnancy in the same collective.…”