Characterizing levator‐ani muscle stiffness pre‐ and post‐childbirth in European and Polynesian women in New Zealand: a pilot study

Kruger, Jennifer; Budgett, Stephanie; Wong, Vivien; Nielsen, Poul M. F.; Nash, Martyn P.; Smalldridge, Jackie; Hayward, Lynsey; Tian, Tania Y.; Taberner, Andrew J.

doi:10.1111/aogs.13186

Cited by 22 publications

(24 citation statements)

References 32 publications

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“…Other groups have developed devices that improve the reliability of the measurement of intravaginal pressure, laxity of the vaginal wall, and mechanical strain but these devices do not address the entire vaginal wall simultaneously …”

Section: Introductionmentioning

confidence: 99%

“…6 Other groups have developed devices that improve the reliability of the measurement of intravaginal pressure, 7-10 laxity of the vaginal wall, [11][12][13][14] and mechanical strain but these devices do not address the entire vaginal wall simultaneously. 15,16 Localized measurements of the mechanical properties of vaginal tissue in vivo using skin elasticity 13,14 have revealed reduced elastic modulus in women with POP compared to women with normal vaginal support. This device measured the deflection of tissue in response to a slight vacuum applied over a small area of the vaginal wall.…”

mentioning

confidence: 99%

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A fiber‐optic sensor‐based device for the measurement of vaginal integrity in women

Parkinson

Rosamilia

Mukherjee

et al. 2019

Neurourology and Urodynamics

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Aims Pelvic floor disorders (PFDs) in women are a major public health concern. Current clinical methods for assessing PFDs are either subjective or confounded by interference from intra‐abdominal pressure (IAP). This study introduces an intravaginal probe that can determine distributed vaginal pressure during voluntary exercises and measures the degree of vaginal tissue support independent of IAP fluctuations. Methods An intravaginal probe was fabricated with 18 independent fiber‐optic pressure transducers positioned along its upper and lower blades. Continuous pressure measurement along the anterior and posterior vaginal walls during the automated expansion of the probe enabled the resistance of the tissue to be evaluated as a function of displacement, in a manner reflecting the elastic modulus of the tissue. After validation in a simulated vaginal phantom, in vivo measurements were conducted in the relaxed state and during a series of voluntary exercises to gauge the utility of the device in women. Results The probe reliably detected variations in the composition of sub‐surface material in the vaginal phantom. During in‐vivo measurements the probe detected distributed tissue elasticity in the absence of IAP change. In addition, the distribution of pressure along both anterior and posterior vaginal walls during cough, Valsalva and pelvic floor contraction was clearly resolved with a large variation observed between subjects. Conclusions Our data highlight the potential for the probe to assess the integrity of the vagina wall and support structures as an integrated functional unit. Further in vivo trials are needed to correlate data with clinical findings to assist in the assessment of PFDs.

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Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

A fiber‐optic sensor‐based device for the measurement of vaginal integrity in women

Parkinson

Rosamilia

Mukherjee

et al. 2019

Neurourology and Urodynamics

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“…Briefly, the patient was first instructed to perform a maximum voluntary contraction of her perineal muscles whilst the PFM was palpated clinically to determine the optimal placement of the speculum at the level of the PFM. Following insertion of the speculum in the closed position, the device was opened in 10mm stepwise increments to a maximum tolerated aperture of 40 mm (which demonstrated high reliability in preliminary studies), slightly lower than previously reported [17] as some women with OASI could not tolerate the 50-mm aperture. At each step, force measurements were acquired over 1 s after a 3-s relaxation time.…”

Section: Vaginal Elastometrymentioning

confidence: 95%

“…Stiffness values are quantified in Newton/m (N/m). The portable device prototype is highly acceptable, consistent and repeatable in both non-pregnant and pregnant women [17]. The measurements were carried out by a single trained operator-the research nurse/midwife-employing a predefined protocol as previously described [17].…”

Section: Vaginal Elastometrymentioning

confidence: 99%

“…The portable device prototype is highly acceptable, consistent and repeatable in both non-pregnant and pregnant women [17]. The measurements were carried out by a single trained operator-the research nurse/midwife-employing a predefined protocol as previously described [17]. Briefly, the patient was first instructed to perform a maximum voluntary contraction of her perineal muscles whilst the PFM was palpated clinically to determine the optimal placement of the speculum at the level of the PFM.…”

Section: Vaginal Elastometrymentioning

confidence: 99%

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Postnatal pelvic floor muscle stiffness measured by vaginal elastometry in women with obstetric anal sphincter injury: a pilot study

et al. 2019

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Introduction and hypothesis Vaginal childbirth is associated with pelvic floor muscle (PFM) damage in a third of women. The biomechanics prediction, detection and management of PFM damage remain poorly understood. We sought in this pilot study to determine whether quantifying PFM stiffness postnatally by vaginal elastometry, in women attending a perineal trauma clinic (PTC) within 6 months of obstetric anal sphincter injury, correlates with their antecedent labour characteristics, pelvic floor muscle damage, or urinary/bowel/sexual symptoms, to inform future definitive prospective studies. Methods In this pilot study, we measured postnatal PFM stiffness by vaginal elastometry in 54 women. A subset of participants (n = 14) underwent magnetic resonance imaging (MRI) to define any levator ani (LA) muscle defects from vaginal childbirth. We investigated the association of PFM stiffness with demographics, labour and delivery characteristics, clinical features and MRI evidence of LA damage. Results Raised maternal BMI was associated with reduced pelvic floor stiffness (r = −0.4; p < 0.01). Higher stiffness values were associated with forceps delivery for delayed second stage of labour (n = 14) vs non-forceps vaginal delivery (n = 40; 630 ± 40 N/ m vs 500 ± 30 N/m; p < 0.05), and a non-significant trend towards longer duration of the second stage of labour. Women with urinary, bowel or sexual symptoms (n = 37) demonstrated higher pelvic floor stiffness values than those without (570 ± 30 N/m vs 450 ± 40 N/m; p < 0.05). Conclusions A history of delayed second stage of labour and forceps delivery was associated with higher PFM stiffness values in the postnatal period. Whether high pelvic muscle stiffness antenatally is a risk factor for instrumental vaginal delivery and LA avulsion is unknown.

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In vivo assessment of the levator ani muscles using shear wave elastography: a feasibility study in women

et al. 2018

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Characterizing levator‐ani muscle stiffness pre‐ and post‐childbirth in European and Polynesian women in New Zealand: a pilot study

Abstract: Quantification of levator-ani muscle stiffness is feasible. Muscle stiffness is significantly different before and after birth.

Cited by 22 publications

References 32 publications

A fiber‐optic sensor‐based device for the measurement of vaginal integrity in women

A fiber‐optic sensor‐based device for the measurement of vaginal integrity in women

Postnatal pelvic floor muscle stiffness measured by vaginal elastometry in women with obstetric anal sphincter injury: a pilot study

In vivo assessment of the levator ani muscles using shear wave elastography: a feasibility study in women

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