Pelvic floor assessment using magnetic resonance imaging after vaginal delivery and elective caesarean delivery

Zhou, Biao; Zhang, Hongbo; Yuan, Jianpeng; Bu, Chao; Lai, Weijian

doi:10.1007/s00192-020-04514-y

Cited by 2 publications

(2 citation statements)

References 21 publications

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“…MRI study by Sebastien Novellas et al also suggests that active labor during the time of a cesarean induces early lesions of the pelvic floor muscles 6 . As most of the previous studies revealed that the recovery of pelvic floor after uncomplicated vaginal delivery occurred during the the first months postpartum, 20,21 and the LVOL did not show any signs of restoration at 10 months postpartum regardless of delivery mode in our study, we speculate that LA atrophy is probably irreversible. The etiology of those findings might be explained by neurophysiological and anatomical studies which have repeatedly demonstrated that vaginal childbirth, or even just the attempt at vaginal delivery may have a negative effect on nervous structures supplying the pelvic floor muscles 22–24 .…”

Section: Discussionsupporting

confidence: 67%

Three‐dimensional magnetic resonance imaging assessment of levator ani in women progressing from full‐term pregnancy to 10 months postpartum

Liu

Peng

et al. 2022

J of Obstet and Gynaecol

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Aim: To identify the anatomical morphology of levator ani (LA) in primigravidae at term pregnancy and its natural process of changing after delivery. Methods: Forty-one primigravidae (vaginal delivery: 29 women, cesarean delivery in the first stage of labor: 12 women) underwent magnetic resonance imaging (MRI) at full-term pregnancy, 6 weeks and 10 months postpartum. Three-dimensional (3-D) model of LA created from MRI data using Mimics v.21.0 software and source images were assessed to determine the morphology. LA volume (LVOL) was calculated and used as indicator of muscle atrophy. Results: Decrease of levator hiatus length (LH-L) was shown in both groups since 6 weeks postpartum. In the vaginal delivery group, the differences in LVOL between time points were significant (p < 0.05), showing a persistent decreasing tendency. Puborectalis attachment width (PAW) on the left was the smallest at 6 weeks postpartum (p < 0.05). LA avulsion and significant 2-D morphological change after delivery were only observed in this group (p < 0.05); In the cesarean section group, smaller LVOL was found at 6 weeks postpartum comparing with full-term pregnancy (p < 0.05); Larger levator-symphysis gap (LSG) and levator hiatus width (LH-W), smaller PAW were observed in vaginal delivery group comparing with cesarean section group at 6 weeks postpartum (p < 0.05), but none of the values exhibited between-group differences (p > 0.05) at 10 months postpartum. No other comparisons were considered significant (p >0.05). Conclusions: Vaginal delivery, or even active labor itself may both lead to LA atrophy. And the morphology of LA is basically similar in different delivery modes at 10 months postpartum once the onset of labor has occurred, even though it changes more complicatedly after vaginal delivery.

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Section: Discussionsupporting

confidence: 67%

Three‐dimensional magnetic resonance imaging assessment of levator ani in women progressing from full‐term pregnancy to 10 months postpartum

Liu

Peng

et al. 2022

J of Obstet and Gynaecol

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“…In contrast, ultrasounds and clinical examinations are inaccessible [12]. Additionally, several studies demonstrated that pelvic oor MRI was widely approved in simultaneously manifesting pelvic oor abnormalities, including injury conditions and pelvic oor dysfunction diseases [13].…”

Section: Introductionmentioning

confidence: 99%

The interrelationship of childbirth-related pelvic floor injury in primiparas after vaginal delivery

Zhang

Zhao²,

Ye³

et al. 2023

Preprint

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Objective This study aimed to explore the underlying relationship between the pubic bone injury and levator ani muscle injury. Methods 150 primiparas after vaginal delivery were prospectively enrolled and divided into the pubic bone injury group and the non-pubic bone injury group according to imaging appearance on postpartum magnetic resonance imaging. The levator ani muscle morphology and function were evaluated, including injury score, H line, M line, levator plate angle, iliococcygeal angle, and levator hiatus area. The levator ani muscle morphology and function were compared between the two groups using univariate analysis. The association between the severity of the pubic bone injury and the levator ani muscle injury was calculated using the Spearman or Kendall's tau-b correlation coefficient. Results Compared to the non-pubic bone injury group, the pubic bone injury group more frequently complained of pelvic pain and stress incontinence (28% vs. 9.3%, P = 0.003; 29.3% vs. 13.3%, P = 0.017, respectively). The levator ani muscle morphological injury score, the H line at straining, the M line, and the levator hiatus area at rest and straining were different between the two groups (all P < 0.05). There was a positive correlation between the severity of the pubic bone injury and levator ani muscle injury score (r = 0.332), M line (r = 0.139, 0.150), and levator hiatus area (r = 0.181, 0.164) at rest and straining, respectively (all P < 0.05). Conclusions The pubic bone injury was a reliable reminder of morphological injury and decreased function in levator ani muscle.

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Pelvic floor assessment using magnetic resonance imaging after vaginal delivery and elective caesarean delivery

Cited by 2 publications

References 21 publications

Three‐dimensional magnetic resonance imaging assessment of levator ani in women progressing from full‐term pregnancy to 10 months postpartum

Three‐dimensional magnetic resonance imaging assessment of levator ani in women progressing from full‐term pregnancy to 10 months postpartum

The interrelationship of childbirth-related pelvic floor injury in primiparas after vaginal delivery

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