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Pelvic Floor Ultrasound Findings and Symptoms of Pelvic Floor Dysfunction During Pregnancy

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Abstract

Introduction and Hypothesis

Pregnancy and childbirth predispose to pelvic floor dysfunction (PFD), coinciding with functional and anatomical changes in the pelvic floor. To some extent, these can be assessed by transperineal ultrasound (TPUS), yet the correlation between ultrasound findings and symptoms has not been well elucidated. We hypothesised that pregnant women with PFD would show different findings at TPUS.

Methods

This is a planned secondary analysis of a prospective cohort study. Pregnant women were asked to fill out standardised questionnaires on PFD and undergo TPUS at 12–14 weeks and 28–32 weeks of gestation. We compared bladder neck descent, urethral rotation, retrovesical angle, pelvic organ descent, genital hiatus dimensions and the presence of anal sphincter defects between women with and those without PFD using t test and Fisher’s exact test. Linear mixed-effects models were used to assess the correlation between TPUS findings and PFD severity. As this is a secondary subgroup analysis of participants who underwent TPUS, no sample size was determined upfront.

Results

At Valsalva, women with urinary incontinence had more pronounced bladder neck descent (p = 0.02) and urethral rotation (p < 0.01), as well as wider retrovesical angles (p = 0.04) and larger genital hiatus areas (p < 0.01). After controlling for age, BMI and parity, the retrovesical angle was the only persistent predictor of urinary incontinence. No correlation was observed between any TPUS marker and symptoms of either prolapse or anorectal dysfunction.

Conclusions

In pregnant women, symptoms of urinary incontinence, but not of prolapse and anorectal dysfunction, are associated with differences in pelvic floor anatomy at TPUS.

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Data Availability

Data available on request due to privacy/ethical restrictions.

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Acknowledgements

We wish to acknowledge the help provided by the midwifes of the outpatient clinic for inviting potential participants to the study. We are grateful to Mrs. Janice Chua Koh for her precious assistance in the study data management.

Funding

Our research group has received educational grants from GE Healthcare, which have been handled by the KU Leuven Transfer Office, though not for conducting this study. There has been no financial support for this work.

Author information

Author notes

  1. Adela Samešova

    Present address: Department of Development and Regeneration, Cluster Urogenital Surgery, Biomedical Sciences, KU Leuven, Herestraat 49, 3000, Louvain, Belgium

Authors and Affiliations

  1. Department of Development and Regeneration, Cluster Urogenital Surgery, Biomedical Sciences, KU Leuven, Herestraat 49, 3000, Louvain, Belgium

    Laura Cattani, Dominique Van Schoubroeck, Bram Packet, Susanne Housmans & Jan Deprest

  2. Department of Gynaecology and Obstetrics, UZ Leuven, Louvain, Belgium

    Laura Cattani, Dominique Van Schoubroeck, Bram Packet, Susanne Housmans & Jan Deprest

  3. Third Faculty of Medicine, Institute for the Care of Mother and Child, Charles University, Prague, Czech Republic

    Adela Samešova

  4. Research Department of Maternal Fetal Medicine, Institute for Women’s Health, University College London, London, UK

    Jan Deprest

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  1. Laura Cattani
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Contributions

L. Cattani: protocol/project development, data collection, data analysis, manuscript writing; D. Van Schoubroeck: protocol/project development, data collection, manuscript editing; A. Samešova: data collection, manuscript editing; B. Packet: data collection, manuscript editing; S. Housmans: data collection, manuscript editing; J. Deprest: protocol/project development, manuscript writing/editing.

Corresponding author

Correspondence to Jan Deprest.

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Ethical Approval

The study was approved by the local Ethical Commission Research of the University Hospitals Leuven (NCT03591393) and all participants gave written informed consent.

Conflicts of Interest

The authors have no conflicts of interest associated with this publication.

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Handling Editor: Symphorosa SC Chan

Editor in Chief: Maria A. Bortolini

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Cattani, L., Van Schoubroeck, D., Samešova, A. et al. Pelvic Floor Ultrasound Findings and Symptoms of Pelvic Floor Dysfunction During Pregnancy. Int Urogynecol J (2024). https://doi.org/10.1007/s00192-024-05931-z

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