Pelvic floor biometry during a first singleton pregnancy and the relationship with symptoms of pelvic floor disorders: a prospective observational study

Abstract

Objective To assess pelvic floor biometry during pregnancy and the correlation with symptoms of pelvic floor disorders in women.Design A prospective observational study. Setting Antenatal clinic between August 2009 and May 2011.Population Nulliparous women in their first pregnancy.Methods Pelvic floor was assessed by translabial ultrasound and symptoms of pelvic floor disorders were explored with a standardised questionnaire at each trimester.Main outcome measures Pelvic floor biometry during pregnancy.Results A total of 405 (91.6%) women completed the study. As the pregnancy advanced, there was significant descent of the bladder neck (BN), cervix, and anorectal junction. The hiatal area (HA) was significantly enlarged, with a mean increase of 15.1 AE 24.8% at rest, and 24.7 AE 28.5% at Valsalva, at third trimester when compared with first trimester. Risk factors for stress urinary incontinence (SUI) were: descent of BN at Valsalva (OR 3.2, 95% CI 1.2-8.5), increase in HA at pelvic floor contraction (PFMC; OR 1.3, 95% CI 1.0-1.6), and increase in maternal age (OR 1.1, 95% CI 1.0-1.2), at first trimester; increase in HA at PFMC (OR 1.3, 95% CI 1.1-1.5) at second trimester; and descent of BN at rest (OR 2.3, 95% CI 1.1-4.9) and increase in maternal age (OR 1.1, 95% CI 1.02-1.2) at third trimester. Descent of anorectal junction (OR 1.5, 95% CI 1.1-1.9) and increase in HA at rest (OR 1.2, 95% CI 1.0-1.3) were factors for prolapse symptoms at second and third trimester, respectively.Conclusions Pelvic floor changes begin during pregnancy. There was significant descent of the BN, cervix, and anorectal junction, and enlargement of the hiatal area, as the pregnancy advanced. SUI was associated with descent of the BN, and prolapse symptoms were associated with an increase in the hiatal area.Keywords Pelvic floor biometry, pelvic floor disorders, pregnancy, translabial ultrasound.Please cite this paper as: Chan SSC, Cheung RYK, Yiu KN, Lee LL, Leung TY, Chung TKH. Pelvic floor biometry during a first singleton pregnancy and the relationship with symptoms of pelvic floor disorders: a prospective observational study. BJOG 2014;121:121-129.

Longitudinal follow‐up of levator ani muscle avulsion: does a second delivery affect it?

“…Recovery and partial recovery of the pelvic floor structures, such as the bladder neck, within 12 months following childbirth, have been reported previously. Miller et al .…”

“…Recovery and partial recovery of the pelvic floor structures, such as the bladder neck, within 12 months following childbirth, have been reported previously 24,25 . Miller et al 10 reported healing of maternal pubic bone marrow and LAM edema and of subcortical fracture within 8 months after delivery, but found no substantial change in LAM tears.…”

Recovery of puborectalis muscle after vaginal delivery: an ultrasound study

“…Strengths of our study include its longitudinal design with nine follow-up timepoints, from 1 day up to 24 weeks postpartum. Another strength is the comparison between hiatal areas postpartum and those at 12 weeks' gestation, and since hiatal area increases as the pregnancy advances 5,6,18 , hiatal dimensions in the first trimester are probably closest to prepregnancy values. Limitations of our study include the small study population and lack of prepregnancy values.…”

Predicting stress urinary incontinence during pregnancy: combination of pelvic floor ultrasound parameters and clinical factors

“…Second, our previous study (21) showed that multiparous women experienced more obvious SUI symptoms and pelvic floor structure changes during pregnancy compared with nulliparous women. However, studies exploring the relation between urinary incontinence during pregnancy and pelvic structure merely took nulliparity into consideration (29,30). In the current study, both nulliparous and multiparous women were investigated, meaning that multiparous women could also be assessed by the nomogram.…”