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Shick-Naveh L.1
1Hadassah Medical Organization, Physiotherapy, Jerusalem, Israel
Background: In recent years, the effects of parturition on the female pelvic floor have been the focus of intensive research. Correlation of the sonographic finding of levator ani muscle (LAM) injuries with clinical examination in primiparous women following vaginal delivery has not been fully described.
Purpose: We aimed to examine the correlation of 3DTUS finding of LAM defect with results of clinical examination of the pelvic floor, at intermediate follow-up.
Methods: Subjects were primiparas 3-21 months following vaginal delivery, who had not become pregnant or delivered in the interim. On 3DTUS, LAM trauma was diagnosed when discontinuity and distortion were visible in the most antero-medial part of the pubovisceral muscle in the coronal C-plane or rendered image. Clinical examination was performed by a physiotherapist who was blinded to ultrasound results, and included palpation of the medial and lateral parts of the levator ani muscle mass, evaluation of tissue quality and whether there was any palpable gap. Muscle strength was evaluated with the modified Oxford scale.
Results: Eighty-seven women were included: 19/87 (21.8%) were found to have sonographic LAM injury. Oxford score palpation parameter of asymmetrical muscle mass or texture was significantly correlated with finding of LAM defect: Of 68 women with normal 3DTUS, 22 (32%) were found to have asymmetry of muscle mass or tissue quality on clinical exam, vs. 12/19 (63%) women with sonographic evidence of LAM injury (p=0.016). Muscle strength and endurance parameters did not significantly correlate with 3DTUS findings.
Conclusion(s): Our findings suggest that persistent 3DTUS LAM injury after primary vaginal delivery has clinical expression in changes in mass and texture of the LAM as assessed by palpation.
Implications: It has been shown that prenatal preventative interventions are effective in reducing pelvic floor problems postnatally. Women found to have evidence of LA defect may be at higher risk of developing pelvic floor problems later in life, and may also benefit from exercises to strengthen and maintain this complex system. Our approach may help identify high-risk women who may be referred for pelvic floor physiotherapy.
Funding acknowledgements: The work was unfunded
Topic: Women's & mens pelvic health
Ethics approval: Institutional Review Board of Hadassah-Hebrew University Medical Centers approved the study
All authors, affiliations and abstracts have been published as submitted.
