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Ultrasonographic evaluation of pelvic floor structure at antepartum and postpartum periods using three-dimensional transperineal ultrasound

  • Original Article–Obstetrics & Gynecology
  • Published:
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Abstract

Purpose

To examine the changes in the pelvic floor structure caused by pregnancy and delivery.

Methods

A total of 141 nulliparous women were examined with three-dimensional transperineal ultrasound (3D-TPU) at the 24th and 34th weeks of gestation, 5th day postpartum, and 1 month postpartum. Puborectalis muscle trauma was diagnosed and the area of levator hiatus (ALH) was measured.

Results

One hundred and five normal vaginal deliveries, 19 vacuum/forceps deliveries, and 17 cesarean deliveries were included. In the normal delivery group, the rate of puborectalis muscle trauma was low and showed no significant change between the 24th and 34th weeks of gestation (12.5% vs. 17.2%, p = 0.42). The rate of trauma significantly increased to 70.2% at the 5th day postpartum (p < 0.001). There was no significant difference between the rates at the 5th day postpartum and 1 month postpartum (73.7%, p = 0.60). The same trend was found in the vacuum/forceps group. In the cesarean section group, no significant change was observed throughout pregnancy and postpartum periods. In the normal delivery group, ALH significantly increased between the 24th and 34th week (14.1 ± 2.6 cm2 vs. 14.6 ± 3.4 cm2, p = 0.007). ALH markedly increased to 20.9 ± 4.8 cm2 at the 5th day postpartum (p < 0.001). ALH at 1 month postpartum decreased to 17.0 ± 4.3 cm2 (p < 0.001), but did not return to the value at the 24th week (p < 0.001).

Conclusions

Vaginal childbirth results in enlargement of the levator hiatus. Pelvic floor muscles in pregnant women are affected not only by mechanical damage associated with delivery but also by physiologic changes during pregnancy. The effects of pregnancy and delivery on pelvic floor muscles may persist after delivery.

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Acknowledgements

We would like to thank Honorary Professor Ichiro Nagata, Department of Obstetrics, National Defense Medical College, and Dr. Koichi Kobayashi, Assistant Director, Tokyo Yamate Medical Center, and Director of the Department of Obstetrics and Gynecology, for their advice regarding the study design and analysis of the results.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Nerima-Hikarigaoka Hospital, Japan Association for Development of Community Medicine, 2-11-1 Hikarigaoka, Nerima-ku, Tokyo, 1790072, Japan

    Manabu Nishibayashi

  2. Department of Obstetrics and Gynecology, Saitama Medical University, 38 Morohongo Moroyama-machi, Iruma-gun, Saitama, 3500495, Japan

    Ryugo Okagaki

Authors
  1. Manabu Nishibayashi
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  2. Ryugo Okagaki
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Correspondence to Manabu Nishibayashi.

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The authors declare that they have no conflicts of interest.

Ethical considerations

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (Institutional Review Board of Nerima Hikarigaoka Hospital) and with the Helsinki Declaration of 1964 and later versions.

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Informed consent was obtained from all patients for being included in the study.

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Nishibayashi, M., Okagaki, R. Ultrasonographic evaluation of pelvic floor structure at antepartum and postpartum periods using three-dimensional transperineal ultrasound. J Med Ultrasonics 48, 345–351 (2021). https://doi.org/10.1007/s10396-021-01100-7

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  • DOI: https://doi.org/10.1007/s10396-021-01100-7

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