PELVIC FLOOR ANATOMY AND FUNCTION 12MONTHS AFTER VAGINAL DELIVERY
I. URBANKOVA, K. GROHREGIN, M.KRCMAR, J. FEYEREISL, L. KROFTA;
Inst. for the care of mother andchild, Prague, Czech Republic.
Introduction: Vaginal childbirthis supposed to be a natural process while given by healthy and youngwomen. However, the process of delivery severely affects not onlyanatomical structures of the pelvic floor (i.e. levator ani muscle)but also its function. Pelvic floor dysfunction (PFD) interferes withindividual’s quality of life.
Objective: To characterizethe effect of delivery on pelvic floor function of vaginally parouswomen following uncomplicated singleton pregnancy.
Methods:A cohort of healthy primiparous women was prospectively followedtrough their delivery and one year postpartum. All included women hadsingleton uncomplicated pregnancy and were giving birth in their 37thweek or beyond. The basic demographical and obstetricalcharacteristic we obtained from the institutional database. Thepelvic floor anatomy and function were evaluated 12 months postpartumusing the transperineal ultrasound, POP-Q and two types of validatedquestioners (International Consultation on Incontinence Questionnaire- ICIQ-SF and Pelvic Organ Prolapse/Urinary Incontinence SexualQuestioner - PISQ 12). The information on pelvic floor functionbefore and during the pregnancy was reported retrospectively duringtheir stay in the six-weeks department. Only women who completed the12-month examination were included in the analysis. The pelvic floorfunction and anatomy were evaluated based on following agecategories; below 28, 28-31, 32-34, above 34. Age categories arebased on their distribution in the originally enrolled cohort at thedelivery. Categorical data, obstetrical followup, POP-Q andsubjective outcome were tested using either Kruskal-Wallis or aChi-square test. Area of the urogenital hiatus (UGH) was normallydistributed, thus tested using One-way ANOVA with a Bonferroni as aposthoc test. Statistical significance ˂0.05.
Results: Intotal 1365 women were included in the study, of which 24 wereexcluded because of pregnancy at the time of 12-month visit. In 354women the delivery had to be terminated by acute caesarean sectionmainly due to fetal hypoxia or dystocia. The evaluation was performedin 987 women, their average age was 31 (min 16, max 46) and BMI 27(min 17, max 52). Before pregnancy stress urinary incontinence andurgencies were reported equally in all age groups (4% and 1.8%,respectively). During the delivery, there was no difference in termsof labor induction, forceps/VEX extraction or fetal weight. In olderwomen, oxytocin was necessary at 84% (p=0.001) and the second stagewas longer (p= 0.003). There were no differences in the occurrence ofthe perineal trauma or episiotomy. In general, all pelvic floorcharacteristics were significantly more compromised in the oldest agegroup (Table 1). Defects of the levator ani muscle (MLA) weredetected in 27.4% of women, however, their distribution among agegroups was comparable. Women above 34 years presented pelvic organprolapse in more compartments in 59%, the ballooning (genital hiatusabove 25cm2) was described in 40% and 45% reported stressurinary incontinence. This was accompanied be a worse score in bothquestioners.
Conclusions: Delayed childbearing above 35years of age is more often related to prolonged second stage of thelabor and secondary weak contractions requiring administration ofoxytocin. Vaginal delivery has more profound effect on their pelvicfloor morphology and function.
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