Pelvic floor muscle dysfunction on 3D/4D transperineal ultrasound in patients with deep infiltrating endometriosis: a pilot study

Self Cite

Objective To assess the effect of levator ani muscle (LAM) coactivation at term on outcome of labor in nulliparous women. Methods This was a prospective study of 284 low‐risk nulliparous women with a singleton pregnancy at term recruited before the onset of labor. The anteroposterior diameter of the levator hiatus was measured in each woman on transperineal ultrasound at rest, on maximum pelvic floor muscle contraction and on maximum Valsalva maneuver before and after visual feedback. LAM coactivation was defined as a reduction in the anteroposterior diameter of the levator hiatus on maximum Valsalva maneuver in comparison with that at rest. The association of pelvic hiatal diameter values and LAM coactivation with mode of delivery and duration of labor was assessed. Results No significant difference was found between women who underwent Cesarean delivery and those who had a vaginal delivery with regard to the anteroposterior diameter of the levator hiatus at rest, on pelvic floor muscle contraction and on Valsalva maneuver. Longer second stage of labor was associated with shorter anteroposterior diameter of the levator hiatus on all assessments, but in particular at rest and on Valsalva both before and after visual feedback. LAM coactivation was found in 89 (31.3%) and 75 (26.4%) women before and after visual feedback, respectively. Post visual feedback, women with LAM coactivation had a significantly longer second stage of labor than did those without LAM coactivation (83 ± 63 vs 63 ± 42 min; P = 0.006). On Cox regression analysis, LAM coactivation post visual feedback was an independent predictor of longer second stage of labor (adjusted hazard ratio, 1.499 (95% CI, 1.076–2.087); P = 0.017). Conclusion LAM coactivation in nulliparous women at term is associated with a longer second stage of labor. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 95%

Levator ani muscle coactivation at term is associated with longer second stage of labor in nulliparous women

Youssef

Montaguti

Dodaro

et al. 2019

Self Cite

“…This may indicate that fetal head descent was obstructed or that the woman had an ineffective pushing technique. We believe that fetal head movement upwards in the birth canal during pushing can be explained by levator ani muscle coactivation instead of relaxation. The effect of coactivation on labor has been assessed recently.…”

Section: Discussionmentioning

confidence: 99%

Descent of fetal head during active pushing: secondary analysis of prospective cohort study investigating ultrasound examination before operative vaginal delivery

Kahrs

Usman

Ghi

et al. 2019

Self Cite

Objectives To investigate if descent of the fetal head during active pushing is associated with duration of operative vaginal delivery, mode of delivery and neonatal outcome in nulliparous women with prolonged second stage of labor. Methods This was a prospective cohort study of nulliparous women with prolonged second stage of labor, conducted between November 2013 and July 2016 in five European countries. Fetal head descent was measured using transperineal ultrasound. Head–perineum distance (HPD) was measured between contractions and on maximum contraction during active pushing, and the difference between these values (ΔHPD) was calculated. The main outcome was duration of operative vaginal delivery, estimated using survival analysis to calculate hazard ratios (HRs) for vaginal delivery, with values > 1 indicating a shorter duration. HR was adjusted for prepregnancy body mass index, maternal age, induction of labor, augmentation with oxytocin and use of epidural analgesia. Pregnancies were grouped according to ΔHPD quartile, and delivery mode and neonatal outcome were compared between groups. Results The study population comprised 204 women. Duration of vacuum extraction was shorter with increasing ΔHPD. Estimated mean duration was 10.0, 9.0, 8.8 and 7.5 min in pregnancies with ΔHPD in the first to fourth quartiles, respectively, and the adjusted HR for vaginal delivery, using increasing ΔHPD as a continuous variable, was 1.04 (95% CI, 1.01–1.08). Mean ΔHPD was 7 mm (range, −10 to 37 mm). ΔHPD was either negative or ≤ 2 mm in the lowest quartile. In this group, 7/50 (14%) pregnancies were delivered by Cesarean section, compared with 8/154 (5%) of those with ΔHPD > 2 mm (P < 0.05). There was no significant association between umbilical artery pH < 7.10 or 5‐min Apgar score < 7 and ΔHPD quartile. Conclusion Minimal or no fetal head descent during active pushing was associated with longer duration of operative vaginal delivery and higher frequency of Cesarean section in nulliparous women with prolonged second stage of labor. © 2019 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.

“…In addition to the classical pain syndrome of DIE (characterized by dysmenorrhea, dyspareunia, chronic pelvic pain, dysuria and dyschezia), deep lesions are associated with dysfunction of the pelvic organs and pelvic floor muscle (PFM). A series of events or combination of factors may contribute to the development of non‐relaxing PFM disorder in women with chronic pelvic pain, including direct or indirect (neuropathic) injury to the pelvic floor muscle, pelvic pain symptoms and inflammation.…”

Section: Introductionmentioning

confidence: 99%

“…Transperineal ultrasound has been shown to be a valid, reliable and non‐invasive tool for the assessment of pelvic floor morphometry. We have previously demonstrated that women with DIE have a smaller levator hiatal area (LHA) at rest and during dynamic maneuvers on three‐ (3D) and four‐dimensional (4D) transperineal ultrasound than do those without DIE, suggesting higher muscular tone and lower strength.…”

Section: Introductionmentioning

confidence: 99%

Pelvic floor muscle assessment on three‐ and four‐dimensional transperineal ultrasound in women with ovarian endometriosis with or without retroperitoneal infiltration: a step towards complete functional assessment

Mabrouk

Raimondo

Forno

et al. 2018

Self Cite