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

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Abstract

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.

Methods

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.

Results

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.

Conclusion

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.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, La Miletrie University Hospital, 2 rue de la Milétrie CS90577, 86021, Poitiers Cedex, France

    Bertrand Gachon, Xavier Fritel, Fabrice Pierre & David Desseauve

  2. Pʹ Institute – RoBioSS Unit, Poitiers University – ENSMA, CNRS UPR 3346, Futuroscope, France

    Bertrand Gachon, Laetitia Fradet, Arnaud Decatoire, Patrick Lacouture & David Desseauve

  3. INSERM, Center for Research in Epidemiology and Population Health (CESP), U1018, Gender, Sexuality and Health Team, Paris-Sud University, UMRS 1018, Villejuif, France

    Xavier Fritel & Henri Panjo

  4. INSERM CIC-P 1402, La Miletrie University Hospital, Poitiers, France

    Xavier Fritel

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  1. Bertrand Gachon
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Correspondence to Bertrand Gachon.

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Gachon, B., Fritel, X., Fradet, L. et al. Is levator hiatus distension associated with peripheral ligamentous laxity during pregnancy?. Int Urogynecol J 28, 1223–1231 (2017). https://doi.org/10.1007/s00192-016-3252-9

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  • DOI: https://doi.org/10.1007/s00192-016-3252-9

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