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Clinical and ultrasonographic evaluation of the pelvic floor in primiparous women: a cross-sectional study

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Abstract

Introduction and hypothesis

We used clinical examination and transperineal 3D/4D ultrasound (US) to evaluate pelvic floor muscles (PFM) after different delivery modes.

Methods

Women were surveyed using validated questionnaires. PFM were evaluated and classified according to the Modified Oxford Scale following 3D/4D transperineal US. For statistical analysis, Kruskal–Wallis, Mann–Whitney, chi-square, and Fisher exact tests were used.

Results

Fifty-three women were evaluated: 32 with previous vaginal delivery (VD) and 21 with cesarean section (CS) (8 nonelective and 13 elective). No significant difference among groups was observed regarding urinary incontinence (UI) after delivery (p = 0.39), loss of muscle strength referred by the patient (p = 0.48), or evaluated through digital examination (p = 0.87). No patient with elective CS had avulsion, with difference between VD and elective CS (p = 0.008). US evaluation identified no differences in bladder-neck elevation (p = 0.69) or descent (p = 0.65) , and no difference in genital hiatus size (p = 0.35), levator ani thickness (p = 0.35 –0.44), or presence of major or minor levator ani avulsion (p = 0.10).

Conclusions

We evaluated primiparous women within 12 to 24 months of delivery and found that VD was associated with PFM avulsion. There was no difference among VD and nonelective or elective CS in symptomatology or other anatomic alterations evaluated through 3D/4D transperineal US.

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Abbreviations

PFD:

Pelvic floor dysfunction

VD:

Vaginal delivery

PFM:

Pelvic floor muscle

US:

Ultrasound

CS:

Cesarean section

ICIQ-VS:

International Consultation on Incontinence Questionnaire–Vaginal Symptoms

ICIQ-SF:

International Consultation on Incontinence Questionnaire–Short Form

POP-Q:

Pelvic Organ Prolapse Quantification system

BN:

Bladder neck

TUI:

Tomographic ultrasound imaging

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Authors and Affiliations

  1. School of Medicine, University of Campinas (UNICAMP), R. Tessália Vieira de Camargo, 126, Campinas, São Paulo, 13083-887, Brazil

    Camila C. Araujo, Suelene S. A. Coelho, Natalia Martinho, Mariana Tanaka, Rodrigos M. Jales & Cassia R. T. Juliato

  2. Centro Regional Universitário do Espírito Santo do Pinhal – UNIPINHAL, Espirito Santo do Pinhal, Brazil

    Natalia Martinho

Authors
  1. Camila C. Araujo
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  2. Suelene S. A. Coelho
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  3. Natalia Martinho
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  4. Mariana Tanaka
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  5. Rodrigos M. Jales
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  6. Cassia R. T. Juliato
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Correspondence to Camila C. Araujo.

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Araujo, C.C., Coelho, S.S.A., Martinho, N. et al. Clinical and ultrasonographic evaluation of the pelvic floor in primiparous women: a cross-sectional study. Int Urogynecol J 29, 1543–1549 (2018). https://doi.org/10.1007/s00192-018-3581-y

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  • DOI: https://doi.org/10.1007/s00192-018-3581-y

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