MRI changes of pelvic floor and pubic bone observed in primiparous women after childbirth by normal vaginal delivery

Abstract

Objective To identify and characterize changes in the pelvic floor and pubic bone, using magnetic resonance imaging, in primiparous women with normal vaginal delivery, in comparison with nulliparous women. MethodsPelvic MR images from ten primiparous women, 6–7 weeks after normal vaginal delivery, and ten nulliparous women were obtained from January to April 2014. The selected women were scanned using a multiplanar T2FRFSE sequence and T2fsFRFSE sequence. Changes in the pelvic floor and pubic bone in primiparous women, including tears of the levator ani fibers, pubic bone edema, and fractures, were assessed on the MR images in comparison with images from normal nulliparous women. Injury to the levator ani was evaluated and scored. The incidence, location and the extent of injury to the levator ani and pubic bone were characterized further.ResultsEight out of ten primiparous women had imaging abnormalities after normal vaginal delivery. Three women had unilateral tears of the pubococcygeus, in which the defect in the muscle was located at or near its origin at the pubic bone, and one had a pubococcygeus tear accompanied by bilateral spilling of the vagina. Four women had partial tears of the iliococcygeus: one was a bilateral tear, and three were unilateral. None had a tear of the coccygeus. Eight women had pubic bone marrow edema; one was accompanied by a pubic bone fracture line. None of the nulliparous women had any abnormality of the pelvic floor and pubic bone.ConclusionAbnormalities of the pelvic floor and pubic bone were observed in primiparous women but not in nulliparous women. In primiparous women, most levator ani muscle tears are at or near the point of origin, and pubococcygeus injuries are usually accompanied by pubic bone marrow edema.

Demographic features of female urethra length

“…The possible cause of the increased UL in obese women may be the abundance of adipose tissue within and above the pelvic diaphragm. In case of multiple multiparas the shortening of the urethra might be dependent on neurological and muscle damages resulting in lower muscle tone within the pelvic diaphragm …”

“…In case of multiple multiparas the shortening of the urethra might be dependent on neurological and muscle damages resulting in lower muscle tone within the pelvic diaphragm. 24,25 The shown differences of urethral length in the group of multiparas and obese patients regardless from continence status might have clinical importance not as a parameter influencing incidence or LUTS and SUI but as a parameter that might be taken into consideration only in the surgery technique.…”

Combination of tomographic ultrasound imaging and three-dimensional magnetic resonance imaging-based model to diagnose postpartum levator avulsion

“…3D volume rendering and tomographic ultrasound imaging (TUI) have the ability to visualize the axial plane with good spatial and superior temporal resolution 11 – 13 . Additionally, due to its exquisite soft tissue contrast and discriminatory capabilities, MRI is considered to be the most reliable reference standard and has been used to observe levator ani trauma since the 1990s 14 , 15 . The components of the levator ani muscle can be clearly distinguished in MRI scans.…”

Review and clinical experience exploring evidence, clinical efficacy, and safety regarding nonsurgical treatment of feminine rejuvenation

“…There are no established or uniform surgical methods for performing these procedures. Guidelines on patient selection criteria are currently lacking . There are few studies which focus on the sensation of a wide vagina, and it is commonly known that an objective detailed measure to assess vaginal laxity is lacking.…”