Archives of Gynecology and Obstetrics

, Volume 276, Issue 2, pp 133–138

Does water delivery affect pelvic floor? Ultrasound evaluation of perineal function

  • Emanuela Mistrangelo
  • Chiara R. Gaggero
  • Chiara Nadalini
  • Sara G. Mancuso
  • Francesca Esposito
  • Sandra Morano
  • Sergio Costantini
Original Article



The aim of the study is to analyse urethral mobility and excursion of the pubo-rectal angle, using perineal ultrasound, after normal vaginal delivery and water delivery.

Materials and methods

A total of 52 primiparous women were enrolled: 25 who had delivery in water (W Group), 27 who had delivery without using water (NW Group). Every woman underwent perineal ultrasound assessment at 6 months after having given birth. The following parameters were assessed: urethral mobility during Valsalva’s manoeuvre, movement of the pubo-rectal sling angle during contraction of the levator ani muscle.


Data obtained show that the urethral mobility during Valsalva’s manoeuvre is higher in the W Group (34.9°) in comparison to the NW Group (29.5°), without statistically significant differences. The excursion of the pubo-rectal sling angle resulted lower in the W Group (8.7°) than in the NW Group (11.0°), without statistically significant differences.


The present study found no statistically differences in pelvic floor, using perineal ultrasound, between water and “non-water” delivery.


Water delivery Pelvic floor Perineal ultrasound Urethral mobility 


  1. 1.
    Weber AM, Buchsbaum GM, Chen B, Clark AL, Damaser MS, Daneshgari F, Davius G, De Lancey J, Kenton K, Weidner AC, Word RA (2004) Basic science and traslational research in female pelvic floor disorders: proceedings of an NIH-Sponsored Meeting. Neurol Urodyn 23:288–301CrossRefGoogle Scholar
  2. 2.
    O’Boyle AL, O’Boyle JD, Calhoun B, Davis GD (2005) Pelvic organ support in pregnancy and postpartum. Int Urogynecol J Pelvic Floor Dysfunct 16(1):69–72PubMedCrossRefGoogle Scholar
  3. 3.
    Marshall K, Walsh DM, Baxter GD (2002) The effect of a first vaginal delivery on the integrity of the pelvic floor musculature. Clin Rehabil 16(7):795–799PubMedCrossRefGoogle Scholar
  4. 4.
    Costantini S, Esposito F, Nadalini C, Lijoi D, Morano S, Lantieri P, Mistrangelo E (2004) Ultrasound imaging of female perineum: the effect of vaginal delivery on pelvic floor dynamics. Ultrasound Obstet Gynecol 23:298–301CrossRefGoogle Scholar
  5. 5.
    Lal M, H Mann C, Callender R, Radley S (2003) Does cesarean delivery prevent anal incontinence? Obstet Gynecol 101(2):305–412PubMedCrossRefGoogle Scholar
  6. 6.
    Rortveit G, Daltveit Ak, Hannestad YS et al (2003) Urinary incontinence after vaginal delivery or cesarian section. N England J Med 348:900–907CrossRefGoogle Scholar
  7. 7.
    Ochsenbein N, Kurmanavicius J, Huch R, Huch A, Wisser J (2001) Pelvic floor in nulliparous women and after elective cesarean section. Acta Obstet Gynecol Scandinavica 80:611–615CrossRefGoogle Scholar
  8. 8.
    Nygaard I (2005) Should women be offered elective caesarean section in the hope of preserving pelvic floor function? Int Urogynecol J 16:253–254CrossRefGoogle Scholar
  9. 9.
    Sartore A, De Seta F, Maso G, Pregazzi R, Grimaldi E Guaschino S (2004) The effect of mediolateral episiotomy on pelvic floor function after vaginal delivery. Obstet Gynecol 103:669–673PubMedGoogle Scholar
  10. 10.
    MacLennan AH, Taylor AW, Wilson DH, Wilson D (2003) The prevalence of pelvic floor disorders and their relationship to gender, age, parity and mode of delivery. BJOG 110(1):88Google Scholar
  11. 11.
    Meyer S, Hohlfeld P, Achtari C, Russolo A, De Grandi P (2000) Birth trauma: short and long term effects of forceps delivery compared with spontaneous delivery on various pelvic floor parameters. BJOG 107(11):1360–1365PubMedCrossRefGoogle Scholar
  12. 12.
    Peschers UM, Sultan AH, Jundt K, Mayer A, Drinovac V, Dimpfl T (2003) Urinary and anal incontinence after vacuum delivery. Eur J Obstet Gynecol Reprod Biol 110(1):39–42PubMedCrossRefGoogle Scholar
  13. 13.
    Peschers UM, Schaer GN, DeLancey JO, Schuessler B (1997) Levator ani function before and after childbirth. Br J Obstet Gynaecol 104(9):1004–1008PubMedGoogle Scholar
  14. 14.
    Lee SJ, Park JW (2000) Follow-up evaluation of the effect of vaginal delivery on the pelvic floor. Dis Colon Rectum 43(11):1550–1555PubMedCrossRefGoogle Scholar
  15. 15.
    Alderice F, Renfrew M, Marchant S, et al (1995) Labour and birth in water in England and Wales: Survey report. Br J Midwifery 3:375–382Google Scholar
  16. 16.
    Bodner K, Bodner-Adler B, Wierrani F, Mayerhofer K, Fousek C, Niedermayr A, Grunberger W (2002) Effects of water birth on maternal and neonatal outcomes. Wien Klin Wochenschr 114(10–11):391–395PubMedGoogle Scholar
  17. 17.
    Cluett ER, Nikodem VC, McCandlish RE, Burns EE (2004) Immersion in water in pregnancy, labour and birth. Cochrane Database Syst Rev 2:CD000111PubMedGoogle Scholar
  18. 18.
    Otigbah CM, Dhanjal MK, Harmsworth G, Chard T (2000) A retrospective comparison of water births and conventional vaginal deliveries. Eur J Obstet Gynecol Reprod Biol 91(1):15–20PubMedCrossRefGoogle Scholar
  19. 19.
    Sampselle CM, Brink CA, Wells TJ (1989) Digital measurement of pelvic muscle strength in childbearing women. Nurs Res 38:134–138PubMedCrossRefGoogle Scholar
  20. 20.
    Brink CA, Wells TJ, Sampselle CM, Taillie ER, Mayer R (1994) A digital test for pelvic muscle strength in women with urinary incontinence. Nurs Res 43:256–352CrossRefGoogle Scholar
  21. 21.
    Costantini S, Mistrangelo E, Francioso R, Valenzano Menada M, Risso D, Lantieri P (2005) Vaginal versus transabdominal hysterectomy: is mode of hysterectomy to influence pelvic statics or is pelvic statics to influence mode of hysterectomy? Acta Obstet Gynecol Scand 84(4):376–379PubMedCrossRefGoogle Scholar
  22. 22.
    Garland D, Jones (2000) Waterbirth: supporting practice with clinical audit. MIDIRS Midwifery Digest 10(3):333–336Google Scholar
  23. 23.
    Burns E (2001) Waterbirths. MIDIRS Midwifery Digest 11(3):S10–S13Google Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Emanuela Mistrangelo
    • 1
  • Chiara R. Gaggero
    • 1
  • Chiara Nadalini
    • 1
  • Sara G. Mancuso
    • 1
  • Francesca Esposito
    • 1
  • Sandra Morano
    • 1
  • Sergio Costantini
    • 1
  1. 1.Ospedale San Martino, Dipartimento di Ginecologia e OstetriciaUniversity of GenovaGenovaItaly

Personalised recommendations