The impact of childbirth on pelvic floor morphology in primiparous Black South African women: a prospective longitudinal observational study
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Introduction and hypothesis
There is a lack of prospective studies evaluating the impact of childbirth on the pelvic floor in non-white populations. We intended to study delivery-related changes in pelvic floor morphology in Black South African primiparae. We also intended to determine the impact of anatomical changes on symptoms in the postpartum period.
A total of 153 nulliparous women between 35 and 39 weeks gestation were recruited from a district antenatal clinic. All women had a standardized interview, completed the International Consultation on Incontinence Vaginal Symptoms questionnaire followed by three/four dimensional transperineal ultrasonography. This was repeated at 3–6 months postpartum.
Of the 153 women, 84 (54.9%) returned at a mean of 4.8 months postpartum. Of these women, 60 (71.4%) had a vaginal delivery and the remainder a caesarean section (20 emergency and 4 elective). Overall, there were statistically significant increases in bladder neck descent (P = 0.003), pelvic organ descent and levator hiatal distensibility (all P < 0001) at the postpartum assessment. Levator avulsion was diagnosed in nine (15%) of those delivered vaginally. Postpartum vaginal laxity was the commonest bothersome vaginal symptom, reported by 51 women (60.7%).
There is significant alteration in pelvic organ support and levator hiatal distensibility postpartum, with more marked effects in women after vaginal delivery. Of Black primiparous women, 15% sustained levator trauma after their first vaginal delivery.
KeywordsChildbirth Pelvic floor morphology Pelvic floor ultrasonography
We thank Ms. Susan Terblanch B.Com (Hons. Statistics), OLSPS Analytics (Pty) Ltd., South Africa, for assistance with the statistical analysis.
Compliance with ethical standards
Conflicts of interest
Z. Abdool: none.
B.G. Lindeque: none.
H.P. Dietz: unrestricted educational grants from GE Medical.
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