ULTRASSONOGRAPHIC FINDINGS OF PELVIC FLOOR MUSCLES FROM LATE POSTPARTUM WOMEN: COMPARISON BETWEEN WOMEN THAT UNDERWENT CESAREAN AND VAGINAL DELIVERIES
BRITO1, C. JULIATO 2, E. B. DE CASTRO 1, R. M. JALES 1, M. V. ROSIQUE 1, C. C. ARAUJO 1;
1Gynecology and Obstetrics, Univ. of Campinas, Campinas, Brazil, 2Univ. of Campinas, Campinas, Brazil.
Introduction: Pelvic floor dysfunctions (PFD) during pregnancy and postpartum period is a common finding. However, most of the studies aimed to investigate PFD during pregnancy or only 12 months after delivery. Thus, it is important to emphasize that patients with PFD are subject to a higher risk of permanent modifications of the pelvic floor muscles (PFM) after delivery, especially influenced by the delivery route.
Objective: To compare the ultrasonographic findings of the pelvic floor muscles from women in late postpartum (12-18 months) that underwent vaginal and cesarean deliveries
Methods: A cross-sectional study was performed with thirty-eight postpartum women after 12-18 months (group A: vaginal delivery; n=24 and group B: cesarean section; n=14) that returned to a postpartum visit. Quality of life, genital prolapse and urinary incontinence (UI) symptoms were assessed by ICIQ-VS and ICIQ-SF questionnaires, and objective assessment was done by POP-Q classification, perineal muscle strength by the Oxford scale, and 2D-3D ultrasound PFM assessment. For the latter exam, the following variables were analyzed during rest, abdominal and/or pelvic floor contractions: position of the ureterovesical junction (UVJ - anterior and lateral), levator ani plateau angle, median AP sagittal diameter, anterior-posterior diameter, latero-lateral diameter, genital hiatus area, right and left puborectalis muscle thickness.
Results: Both groups were homogeneous with regard to age (p=.14), BMI (p=.15), race (p=.18), not performing physical exercises (p=.49). Women that underwent vaginal delivery had a higher mean birthweight (3,237 vs. 2997.1 g; p<.05) and no statistical differences with regard to head circumference. Non-elective cesarean sections (22.2%) had twice the duration of birth labor (1,011 vs 513,8 min;p<.05) than vaginal deliveries. All POP-Q measurements from the urogenital diaphragm were similar except for a shorter genital hiatus in normal delivery. A third of women from group A reported a decrease in PFM strength after birth. No differences were seen between groups and the ICIQ questionnaires. With regard to the ultrasound measurements, no differences were seen between groups at all measurements during rest. While contracting the PFM, the UVJ positions were statistically different between groups(p=.02; p= .04, respectively). However, abdominal contraction did not keep this difference and when contracting both together, UVJ position and median AP sagittal diameter were higher for group B (p=.03; p=.02, respectively). No statistical differences were seen when the US variables were analyzed according to the differences during abdominal contractions and resting, pelvic and abdominal contractions, except for one variable between pelvic contractions and resting (UVJ position).
Conclusions: Despite women from the vaginal group complained about a decrease of PFM strength, no differences were seen with regard to the US parameters in both groups. Probably this may be explained due to the fact that the sample size is underpowered to analyze this question. Further increase of the sample is expected in order to answer this question.
References: 1 - BJOG 2012;119(1):51-60. 2 - Ultrasound Obstet Gynecol 2012;39(4):372-83. 3- Ultrasound Obstet Gynecol 2005;25(6):580-5.