abstract126 - MRI COMPARISON OF FEMALE PELVIC FLOOR STRUCTURES BETWEEN NULLIPARAS AND PATIENTS WITH ELECTIVE CAESAREAN SECTION
MRI COMPARISON OF FEMALE PELVICFLOOR STRUCTURES BETWEEN NULLIPARAS AND PATIENTS WITH ELECTIVECAESAREAN SECTION
M. KRCMAR1, L. KROFTA2, J. FEYEREISL 3, I. URBANKOVA 4,K. GROHREGIN 5;
1urogynecology, Inst. forthe care of mother and child, Prague 4, Czech Republic, 2Inst.for the care of mother and child, Prague, Czech Republic, 3Inst.for the care of mother and child, Prague 4, Czech Republic, 4KULeuven, Leuven, Belgium, 5Inst. for the Care of Mother andChild, Prague, Czech Republic.
Introduction: Magnetic resonanceimaging (MRI) is the most accurate method displaying the pelvic floortrauma following vaginal delivery. But what is the influence ofpregnancy itself in development of pelvic organ prolapse?
Objective:We tried to describe pelvic floor damage caused by pregnancy on MRIscans in the group of primiparas delivering by elective C-sectioncompared to the group of nulliparas with the aim to assess thepotential appearance of musculo-fascial defects in different planesof female pelvis.
Methods: This is an unicentric,retrospective and observational study of two groups of women. Group Aconsists of nulliparas, group B consists of women who delivered byelective Caesarean section. None of the study attendants had beensuffering from any symptoms of pelvic floor dysfunction. All thepatient were first examined according to POP-Q system. In allpatients we performed dynamic MRI scan (supine position, 1,5 and 3 T,slicing 2-4mm, gap 1mm) in axial, coronal and sagittal projections.All scans were evaluated independently by two researchers. Axial andsagittal scans and dynamic sequence were evaluated by two independentresearchers. In the axial scans, anatomy was evaluated in twoparallel planes; (1) at the plane of the inferior pubic ligament thatcorresponds to the mid-urethra (pL1), and (2) at the plane defined bythe bladder base (pL2). Following biometric parameters were measured:urogenital hiatus dimensions (anteroposterior dimension, width), thedistance between the urethra and puborectal muscle insertion(urethral gap, UG), levator ani muscle thickness (pubovisceral musclecomplex and iliococcygeal muscle, respectively), the internalobturator muscle thickness (only at pL2). Also the distance betweenpL1 and pL2 was measured. Axial scans were also used to measure thepelvic bones biometry including the sacrococcygeal-inferior pubicpoint distance (SCIPP), the bi-spinal and bi-tuber diameter. Indynamic sequences measurements were done at the rest and at themaximal Valsalva maneuver. We measured the distance between theposterior aspect of the uterine cervix and the sacrococcygealconnection, the levator plate angle, and the sacrouterine angle,which was defined as an angle between the SCIPP line and connectionbetween the sacrococcygeal connection and the posterior aspect of theuterine cervix. The difference between left- and right-sidedmeasurements was compared with a paired T-test (SPSS®,ver. 19).
Results: Group A contains 24 patients, group Bconsists of 18 patients. The mean age at delivery in group A was 32,4years (23-42), in group B 27,6 (22-34), mean BMI 23,2 in group A(17-35) and in group B 22,7 (19-26). Both groups statistically differonly in age. All data showed normal distribution, thus they arereported as mean ± standard deviation, and range. UGH dimensions didno differ significantly.Group A at pL1: urethral gap 14.0mm±2.5 (10; 19), pubovisceral muscle-complex thickness 8.1mm ±1.6 (4;11). At pL2: iliococcygeal muscle thickness 4.6mm ±1.7 (1, 10),obturator muscle thickness 17,6mm ±3.9 (11, 26). The averagedistance between pL1 and pL2 was 21.5mm ±5.0 (12, 30). The bonypelvis dimensions: bispinal diameter 109.2mm ±8.9 (96, 128),bi-tuber distance 128.2mm ±10.4 (109, 149), SCIPP 115.9mm ±25.7(97.0, 146.0), and the interpubic angle 86.3° ±8.9 (96, 128).Dynamic midsagittal sequences: the sacrococcygeal-uterine cervixdistance at the rest 55.0mm ±15.2 (29, 92) and at the Valsalva49.4mm ±10.6 (33, 75); the levator plate angle at relaxation 21.5°±7.1 (11.3, 39) and at Valsalva 34.7° ±10.4 (14.2, 52.3); thesacro-uterine angle at relaxation 30.5° ±9.3 (14.3, 50.1) and atValsalva 19.2° ±12.7 (-8.6, 41.2). Group B at pL1: urethralgap 15mm ±1.9 (9; 20), pubovisceral muscle-complex thickness 5,5mm±1.2 (0; 9). At pL2: iliococcygeal muscle thickness 3,6mm ±2.9 (1,5), obturator muscle thickness 19,5mm ±3.9 (14, 26). The averagedistance between pL1 and pL2 was 18,2mm ±3,4 (16, 20). The bonypelvis dimensions: bispinal diameter 109.6mm ±7,23 (106, 113),bi-tuber distance 130.4mm ±8,4 (115, 143), SCIPP 89,5mm ±52,1(63.0, 115.0), and the interpubic angle 87,7° ±5,8 (78, 99).Dynamic midsagittal sequences: the sacrococcygeal-uterine cervixdistance at the rest 55.0mm ±15.2 (37, 72) and at the Valsalva 51mm±11,1 (33, 68); the levator plate angle at relaxation 18,3° ±6,7(10, 40) and at Valsalva 25° ±10.9 (6, 44); the sacro-uterine angleat relaxation 27,8° ±4,9 (19, 36.1) and at Valsalva 20,1° ±11,1(6, 34).
Conclusions: We found significant differencesbetween those 2 groups in age, PMC, IMC and OIM thickness as well asin LP angle within Valsalva -lower in group B. Those data show, thatsome specific changes in levator ani muscle are can develop evenwithin the pregnancy, not just within the vaginaldelivery.