Dynamic 3T pelvic floor magnetic resonance imaging in women progressing from the nulligravid to the primiparous state
- 193 Downloads
Introduction and hypothesis
The objective was to prospectively characterize dynamic pelvic 3-Tesla magnetic resonance imaging (dp3T MRI) findings in nulligravida women and characterize changes 6 months after delivery in the same woman.
In this prospective study, nulligravida women seeking assisted reproductive technology for pregnancy were recruited. After physical examination by Pelvic Organ Prolapse Quantification (POP-Q), Brink assessment and measures including the Pelvic Floor Distress Inventory-20 and Pelvic Floor Impact Questionnaire-7, pre-pregnancy dp3T MRI at rest, with strain, and evacuation were performed. Assessments were repeated ≥6 months postpartum. Analysis included Welch and paired t tests for continuous variables, Fisher’s exact test for differences in categorical outcomes, and paired t tests for postpartum symptoms.
Nineteen subjects (mean ± SD age, 31 ± 5 years) completed baseline clinical and dp3T MRI studies, 15 delivered and 10 (30.5 ± 3 years) completed pre-pregnancy and post-delivery clinical and dp3T MRI assessments. There were no significant changes in scores of validated questionnaires (all p > 0.05) or on POP-Q measures post-delivery. Two (20%) subjects without pre-pregnancy levator tears had tears on MRI post-delivery. MRI measures of pelvic organ descent were increased post-delivery. Seventeen pelvic soft-tissue parameters increased by greater than 10% post-delivery, including 5 out of 70 (7.1%), 17 out of 110 (15.5%), and 50 out of 110 (45.5%) values exceeding thresholds at rest, strain, and evacuation respectively.
Dynamic pelvic 3T MRI detected levator tears and increased pelvic organ descent, which can be directly attributed to pregnancy and delivery.
KeywordsDynamic pelvic 3T magnetic resonance imaging Levator tear Nulligravida women Pelvic floor mobility Primiparous women
Funded by NICHD 5R03HD061805–02; the NIH had no direct involvement in the design, analysis, or data collection of this study.
Compliance with ethical standards
Conflicts of interest
- 1.Patel DA, Xu X, Thomason AD, Ransom SB, Ivy JS, DeLancey JO. Childbirth and pelvic floor dysfunction: an epidemiologic approach to the assessment of prevention opportunities at delivery. Am J Obstet Gynecol. 2006;195:23–8. https://doi.org/10.1016/j.ajog.2006.01.042.CrossRefPubMedPubMedCentralGoogle Scholar
- 4.Lukacz ES, Lawrence JM, Contreras R, Nager CW, Luber KM. Parity, mode of delivery, and pelvic floor disorders. Obstet Gynecol. 2006;107:1253–60. https://doi.org/10.1097/01.AOG.0000218096.54169.34.CrossRefPubMedGoogle Scholar
- 5.Burgio KL, Borello-France D, Richter HE, Fitzgerald MP, Whitehead W, Handa VL, et al. Risk factors for fecal and urinary incontinence after childbirth: the Childbirth and Pelvic Symptoms Study. Am J Gastroenterol. 2007;102:1998–2004. https://doi.org/10.1111/j.1572-0241.2007.01364.x.CrossRefPubMedGoogle Scholar
- 6.Pollack J, Nordenstam J, Brismar S, Lopez A, Altman D, Zetterstrom J. Anal incontinence after vaginal delivery: a five-year prospective cohort study. Obstet Gynecol. 2004;104:1397–402. https://doi.org/10.1097/01.AOG.0000147597.45349.e8.CrossRefPubMedGoogle Scholar
- 7.Abramov Y, Sand PK, Botros SM, Gandhi S, Miller JJ, Nickolov A, et al. Risk factors for female anal incontinence: new insight through the Evanston-northwestern twin sisters study. Obstet Gynecol. 2005;106:726–32. https://doi.org/10.1097/01.AOG.0000161367.65261.16.CrossRefPubMedGoogle Scholar
- 8.Kearney R, Miller JM, Ashton-Miller JA, DeLancey JO. Obstetric factors associated with levator ani muscle injury after vaginal birth. Obstet Gynecol. 2006;107:144–9. https://doi.org/10.1097/01.AOG.0000194063.63206.1c.CrossRefPubMedPubMedCentralGoogle Scholar
- 9.DeLancey JO, Morgan DM, Fenner DE, Kearney R, Guire K, Miller JM, et al. Comparison of levator ani muscle defects and function in women with and without pelvic organ prolapse. Obstet Gynecol. 2007;109:295–302. https://doi.org/10.1097/01.AOG.0000250901.57095.ba.CrossRefPubMedGoogle Scholar
- 14.Buckett WM, Chian RC, Holzer H, Dean N, Usher R, Tan SL. Obstetric outcomes and congenital abnormalities after in vitro maturation, in vitro fertilization, and intracytoplasmic sperm injection. Obstet Gynecol. 2007;110:885–91. https://doi.org/10.1097/01.AOG.0000284627.38540.80.CrossRefPubMedGoogle Scholar
- 24.Rizk DE, Czechowski J, Ekelund L. Dynamic assessment of pelvic floor and bony pelvis morphologic condition with the use of magnetic resonance imaging in a multiethnic, nulliparous, and healthy female population. Am J Obstet Gynecol. 2004;191:83–9. https://doi.org/10.1016/j.ajog.2003.12.041.CrossRefPubMedGoogle Scholar