International Urogynecology Journal

, Volume 28, Issue 8, pp 1223–1231 | Cite as

Is levator hiatus distension associated with peripheral ligamentous laxity during pregnancy?

  • Bertrand GachonEmail author
  • Xavier Fritel
  • Laetitia Fradet
  • Arnaud Decatoire
  • Patrick Lacouture
  • Henri Panjo
  • Fabrice Pierre
  • David Desseauve
Original Article


Introduction and hypothesis

The impact of pregnancy on pelvic floor disorders remains poorly understood. During pregnancy, an increase in ligamentous laxity and pelvic organ mobility is often reported. Our main objective was to investigate a possible association between peripheral ligamentous laxity and levator hiatus (LH) distension during pregnancy.


This was a prospective longitudinal study of 26 pregnant women followed up from the first to the third trimester. We collected the following information: occurrence of pelvic organ prolapse (POP) symptoms (score higher than 0 for the POP section of the Pelvic Floor Distress Inventory 20 questions score), 4D perineal ultrasound scan results with LH distension assessment and measurement of metacarpophalangeal joint mobility (MCP laxity). The association between MCP laxity and LH distension was estimated by mixed multilevel linear regression. The associations between MCP laxity and categorical parameters were estimated in a multivariate analysis using a generalized estimating equation model.


MCP laxity and LH distension were correlated with a correlation coefficient of 0.26 (p = 0.02), and 6.8% of the LH distension variance was explained by MCP laxity. In the multivariate analysis, MCP laxity was associated with POP symptoms with an odds ratio at 1.05 (95% CI 1.01–1.11) for an increase of 1° in MCP laxity.


LH distension and peripheral ligamentous laxity are significantly associated during pregnancy. However, the relationship is weak, and the results need to be confirmed in larger populations and with more specific techniques such as elastography to directly assess the elastic properties of the pelvic floor muscles.


Levator hiatus Pelvic floor Pelvic floor disorders Ligamentous laxity Pregnancy 


Compliance with ethical standards

Conflicts of interest



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Copyright information

© The International Urogynecological Association 2017

Authors and Affiliations

  1. 1.Department of Obstetrics and GynecologyLa Miletrie University HospitalPoitiers CedexFrance
  2. 2.Pʹ Institute – RoBioSS UnitPoitiers University – ENSMA, CNRS UPR 3346FuturoscopeFrance
  3. 3.INSERM, Center for Research in Epidemiology and Population Health (CESP), U1018, Gender, Sexuality and Health TeamParis-Sud University, UMRS 1018VillejuifFrance
  4. 4.INSERM CIC-P 1402La Miletrie University HospitalPoitiersFrance

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