Abstract
Introduction and hypothesisVaginal childbirth is associated with pelvic floor muscle (PFM) damage in a third of women. The biomechanics prediction, detection and management of PFM damage remain poorly understood. We sought in this pilot study to determine whether quantifying PFM stiffness postnatally by vaginal elastometry, in women attending a perineal trauma clinic (PTC) within 6 months of obstetric anal sphincter injury, correlates with their antecedent labour characteristics, pelvic floor muscle damage, or urinary/bowel/sexual symptoms, to inform future definitive prospective studies.MethodsIn this pilot study, we measured postnatal PFM stiffness by vaginal elastometry in 54 women. A subset of participants (n = 14) underwent magnetic resonance imaging (MRI) to define any levator ani (LA) muscle defects from vaginal childbirth. We investigated the association of PFM stiffness with demographics, labour and delivery characteristics, clinical features and MRI evidence of LA damage.ResultsRaised maternal BMI was associated with reduced pelvic floor stiffness (r = −0.4; p < 0.01). Higher stiffness values were associated with forceps delivery for delayed second stage of labour (n = 14) vs non-forceps vaginal delivery (n = 40; 630 ± 40 N/m vs 500 ± 30 N/m; p < 0.05), and a non-significant trend towards longer duration of the second stage of labour. Women with urinary, bowel or sexual symptoms (n = 37) demonstrated higher pelvic floor stiffness values than those without (570 ± 30 N/m vs 450 ± 40 N/m; p < 0.05).ConclusionsA history of delayed second stage of labour and forceps delivery was associated with higher PFM stiffness values in the postnatal period. Whether high pelvic muscle stiffness antenatally is a risk factor for instrumental vaginal delivery and LA avulsion is unknown.
Highlights
Introduction and hypothesisVaginal childbirth is associated with pelvic floor muscle (PFM) damage in a third of women
Pelvic floor dynamometry or elastometry, has emerged as a potential tool for the functional evaluation of pelvic floor mechanics [11, 12]. In this pilot study we investigated, in the setting of a perineal trauma clinic (PTC), whether PFM stiffness measured by elastometry in the postnatal period correlates with the duration of the second stage of labour and the requirement for instrumental delivery for delayed second stage of labour in the antecedent pregnancy
For the first time, postnatal PFM stiffness measured using a portable vaginal elastometer in a cohort of women attending a postnatal PTC who had experienced major obstetric anal sphincter injury (OASI) during vaginal childbirth
Summary
Introduction and hypothesisVaginal childbirth is associated with pelvic floor muscle (PFM) damage in a third of women. The biomechanics prediction, detection and management of PFM damage remain poorly understood We sought in this pilot study to determine whether quantifying PFM stiffness postnatally by vaginal elastometry, in women attending a perineal trauma clinic (PTC) within 6 months of obstetric anal sphincter injury, correlates with their antecedent labour characteristics, pelvic floor muscle damage, or urinary/bowel/sexual symptoms, to inform future definitive prospective studies. Damage to the LA muscle resulting from vaginal delivery is usually initially undetected because many women are asymptomatic and investigating such injury is not routine [3] Such unrecognized damage may be identified later, for instance, when menopause and aging associated with low oestrogen lead to clinical presentation with pelvic organ prolapse (POP) and/or urinary incontinence (UI) [4]. The latter conditions affect more than 20% of women [5] and significantly diminish quality of life [6]
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