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Ultrasound Obstet Gynecol. 2012 Nov;40(5):570-5. doi: 10.1002/uog.11203.

Does levator trauma 'heal'?

Author information

1
Nepean Clinical School, University of Sydney, Sydney, NSW, Australia. shekkalai@yahoo.com.hk

Abstract

OBJECTIVE:

To evaluate if pregnancy- and delivery-related changes to levator morphology and distensibility regress with time.

METHODS:

488 nulliparous pregnant women, recruited between 36 and 38 weeks' gestation, were invited for assessment at 3-6 months and again at 2-3 years postpartum. All underwent an interview and four-dimensional translabial ultrasound examination. Hiatal morphometry and bladder neck descent (BND) were determined and compared between the two postpartum visits.

RESULTS:

367 participants returned for assessment at 4.1 (interquartile range (IQR), 3.7-5.0) months and 161 returned at 2.6 (IQR, 2.0-3.1) years, allowing a groupwise comparison. There was no significant difference in hiatal area (22 vs 22 cm(2), P = 0.95) or BND on Valsalva maneuver (26.3 vs 25.5 mm, P = 0.49). Pairwise comparison in women who had attended both postpartum appointments without second births (n = 77), separately for those who had a cesarean section (n = 24) and those who had a vaginal delivery (n = 53) originally, showed no significant changes, except a reduction in BND (31.2 vs 28.3 mm, P = 0.025) in those who had delivered vaginally. Two women out of 12 diagnosed with a levator avulsion at 3-6 months showed obvious anatomical improvement on translabial ultrasound at 2-3 years.

CONCLUSIONS:

We found no evidence of regression or healing of pregnancy- and delivery-related changes to levator distensibility on comparing imaging data obtained at 3-6 months and 2-3 years postpartum. However, we documented anatomical improvement on translabial ultrasound at the second postpartum visit in two women diagnosed with levator avulsion at 3-6 months postpartum.

PMID:
22648932
DOI:
10.1002/uog.11203
[Indexed for MEDLINE]
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