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01-08-2018 | General Gynecology

Association between pelvic floor dysfunction, and clinical and ultrasonographic evaluation in primiparous women: a cross-sectional study

Authors: Glaucia Miranda Varella Pereira, Zilma Silveira Nogueira Reis, Beatriz Deoti e Silva Rodrigues, Kelly Cristine Lacerda Rodrigues Buzatti, Maria Cristina da Cruz, Marilene Vale de Castro Monteiro

Published in: Archives of Gynecology and Obstetrics | Issue 2/2018

Abstract

Purpose

Disorders related to pelvic floor include urinary incontinence (UI), anal incontinence, pelvic organ prolapse, sexual dysfunction and pelvic pain. Because pelvic floor dysfunctions (PFD) can be diagnosed clinically, imaging techniques serve as auxiliary tools for establishing an accurate diagnosis. The objective is to evaluate the PFD in primiparous women after vaginal delivery and the association between clinical examination and three-dimensional ultrasonography (3DUS).

Methods

A cross-sectional study was conducted in a in tertiary maternity. All primiparous women with vaginal deliveries that occurred between January 2013 and December 2015 were invited. Women who attended the invitation underwent detailed anamnesis, questionnaire application, physical examination and endovaginal and endoanal 3DUS. Crude and adjusted predictor factors for PFD were analyzed.

Results

Fifty women were evaluated. Sexual dysfunction was the most prevalent PFD (64.6%). When associated with clinical features and PFD, oxytocin use increased by approximately four times the odds of UI (crude OR 4.182, 95% CI 1.149–15.219). During the multivariate analysis, the odds of UI were increased in forceps use by approximately 11 times (adjusted OR 11.552, 95% CI 11.155–115.577). When the clinical and obstetrical predictors for PFD were associated with 3DUS, forceps increased the odds of lesion of the pubovisceral muscle and anal sphincter diagnosed by 3DUS by sixfold (crude OR 6.000, 95% CI 1.172–30.725), and in multivariate analysis forceps again increased the odds of injury by approximately 7 times (adjusted OR 7.778, 95% CI 1.380–43.846).

Conclusion

Sexual dysfunction was the most frequent PFD. The use of forceps in primiparous women was associated with a greater chance of UI and pelvic floor muscle damage diagnosed by 3DUS.

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Dietz HP, Simpson JM (2008) Levator trauma is associated with pelvic organ prolapse. Bjog Int J Obstet Gynaecol 115(8):979–984CrossRef

Bazi T, Takahashi S, Ismail S, Bo K, Ruiz-Zapata AM, Duckett J et al (2016) Prevention of pelvic floor disorders: international urogynecological association research and development committee opinion. Int Urogynecol J 27(12):1785–1795CrossRefPubMed

Bo K, Frawley HC, Haylen BT, Abramov Y, Almeida FG, Berghmans B et al (2017) An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for the conservative and nonpharmacological management of female pelvic floor dysfunction. Neurourol Urodyn 36(2):221–244CrossRefPubMed

Volloyhaug I, van Gruting I, van Delft K, Sultan AH, Thakar R (2016) Is bladder neck and urethral mobility associated with urinary incontinence and mode of delivery 4 years after childbirth? Neurourol Urodyn 24(10):23123. https://doi.org/10.1002/nau.23123 CrossRef

Monteiro MVD, Pereira GMV, Aguiar RAP, Azevedo RL, Correia MD, Reis ZSN (2016) Risk factors for severe obstetric perineal lacerations. Int Urogynecol J 27(1):61–67CrossRef

Mejido JAG, Mejias PV, Palacín AF, Barby MJB, De la Fuente Vaquero P, Bueno JAS (2017) Evaluation of isolatedurinary stress incontinence according to the type of levator ani muscle lesion using 3/4D transperineal ultrasound 36 months post-partum. Int Urogynecol J 28(7):1019–1026CrossRef

Jármy-Di Bella ZIK, Júnior EA, Rodrigues CA, Torelli L, Martins WP, Moron AF et al (2016) Reproducibility in pelvic floor biometric parameters of nulliparous women assessed by translabial three-dimensional ultrasound using Omniview reformatting technique. Med Ultrasonogr 18(3):345–350CrossRef

Guzman Rojas R, Shek K, Langer S, Dietz H (2013) Prevalence of anal sphincter injury in primiparous women. Ultrasound Obstet Gynecol 42(4):461–466PubMed

Dietz HP (2009) Pelvic floor assessment. Fetal Matern Med Rev 20(1):49–66CrossRef

10.

Thiel Rdo R, Dambros M, Palma PC, Thiel M, Riccetto CL, Ramos Mde F (2008) Translation into Portuguese, cross-national adaptation and validation of the Female Sexual Function Index. Rev Bras Ginecol Obstet 30(10):504–510CrossRefPubMed

11.

Edition F (2013) Diagnostic and statistical manual of mental disorders. Am Psychiatr Assoc

12.

Wiegel M, Meston C, Rosen R (2005) The Female Sexual Function Index (FSFI): cross-validation and development of clinical cutoff scores. J Sex Marital Ther 31(1):1–20CrossRefPubMed

13.

Laycock J (1994) Female pelvic floor assessment: the Laycock ring of continence. J Natl Women Health Group Aust Physiother Assoc 1994:40–51

14.

Haylen BT, Maher CF, Barber MD, Camargo S, Dandolu V, Digesu A et al (2016) Erratum to: an International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic organ prolapse (POP). Int Urogynecol J 27(4):655–684CrossRefPubMed

15.

Thom DH, Brown JS, Schembri M, Ragins AI, Creasman JM, Van Den Eeden SK (2011) Parturition events and risk of urinary incontinence in later life. Neurourol Urodyn 30(8):1456–1461CrossRefPubMedPubMedCentral

16.

Casey BM, Schaffer JI, Bloom SL, Heartwell SF, McIntire DD, Leveno KJ (2005) Obstetric antecedents for postpartum pelvic floor dysfunction. Am J Obstet Gynecol 192(5):1655–1662CrossRefPubMed

17.

Svare JA, Hansen BB, Lose G (2014) Risk factors for urinary incontinence 1 year after the first vaginal delivery in a cohort of primiparous Danish women. Int Urogynecol J 25(1):47–51CrossRefPubMed

18.

Karahan N, Arslan H, Çam Ç (2018) The behaviour of pelvic floor muscles during uterine contractions in spontaneous and oxytocin-induced labour. J Obstet Gynaecol 2018:1–6CrossRef

19.

Meyer S, Schreyer A, De Grandi P, Hohlfeld P (1998) The effects of birth on urinary continence mechanisms and other pelvic-floor characteristics. Obstet Gynecol 92(4 Pt 1):613–618PubMed

20.

DeLancey JO, Miller JM, Kearney R, Howard D, Reddy P, Umek W et al (2007) Vaginal birth and de novo stress incontinence: relative contributions of urethral dysfunction and mobility. Obstet Gynecol 110(2 Pt 1):354–362CrossRefPubMedPubMedCentral

21.

DeLancey JOL, Kearney R, Chou Q, Speights S, Binno S (2003) The appearance of levator ani muscle abnormalities in magnetic resonance images after vaginal delivery. Obstet Gynecol 101(1):46–53PubMedPubMedCentral

22.

Foldspang A, Hvidman L, Mommsen S, Bugge Nielsen J (2004) Risk of postpartum urinary incontinence associated with pregnancy and mode of delivery. Acta Obstet Gynecol Scand 83(10):923–927CrossRefPubMed

23.

Hannestad YS, Rortveit G, Sandvik H, Hunskaar S (2000) A community-based epidemiological survey of female urinary incontinence: the Norwegian EPINCONT Study. J Clin Epidemiol 53(11):1150–1157CrossRefPubMed

24.

DeLancey JO, Kearney R, Chou Q, Speights S, Binno S (2003) The appearance of levator ani muscle abnormalities in magnetic resonance images after vaginal delivery. Obstet Gynecol 101(1):46–53PubMedPubMedCentral

25.

MacArthur C, Wilson D, Herbison P, Lancashire RJ, Hagen S, Toozs-Hobson P et al (2016) Urinary incontinence persisting after childbirth: extent, delivery history, and effects in a 12-year longitudinal cohort study. BJOG Int J Obstet Gynaecol 123(6):1022–1029CrossRef

26.

Dietz HP, Steensma AB (2006) The prevalence of major abnormalities of the levator ani in urogynaecological patients. BJOG 113(2):225–230CrossRefPubMed

27.

Murad-Regadas SM, Fernandes GOD, Regadas FSP, Rodrigues LV, Pereira JDR, Dealcanfreitas ID (2014) Assessment of pubovisceral muscle defects and levator hiatal dimensions in women with faecal incontinence after vaginal delivery: is there a correlation with severity of symptoms? Colorectal Dis 16(12):1010–1018CrossRefPubMed

28.

Varma A, Gunn J, Gardiner A, Lindow SW, Duthie GS (1999) Obstetric anal sphincter injury: prospective evaluation of incidence. Dis Colon Rectum 42(12):1537–1543CrossRefPubMed

29.

Dietz HP, Shek C (2008) Levator avulsion and grading of pelvic floor muscle strength. Int Urogynecol J Pelvic Floor Dysfunct 19(5):633–636CrossRefPubMed

30.

Kearney R, Miller JM, Delancey JO (2006) Interrater reliability and physical examination of the pubovisceral portion of the levator ani muscle, validity comparisons using MR imaging. Neurourol Urodyn 25(1):50–54CrossRefPubMedPubMedCentral

31.

Dietz HP, Mann KP (2014) What is clinically relevant prolapse? An attempt at defining cutoffs for the clinical assessment of pelvic organ descent. Int Urogynecol J 25(4):451–455CrossRefPubMed

32.

Kahramanoglu I, Baktiroglu M, Hamzaoglu K, Kahramanoglu O, Verit FF, Yucel O (2017) The impact of mode of delivery on the sexual function of primiparous women: a prospective study. Arch Gynecol Obstet 295(4):907–916CrossRefPubMed

33.

Meriwether KV, Rogers RG, Dunivan GC, Alldredge JK, Qualls C, Migliaccio L et al (2016) Perineal body stretch during labor does not predict perineal laceration, postpartum incontinence, or postpartum sexual function: a cohort study. Int Urogynecol J 27(8):1193–1200CrossRefPubMedPubMedCentral

34.

Wallwiener S, Müller M, Doster A, Kuon RJ, Plewniok K, Feller S et al (2017) Sexual activity and sexual dysfunction of women in the perinatal period: a longitudinal study. Arch Gynecol Obstet 295(4):873–883CrossRefPubMed

35.

Menees SB, Smith TM, Xu X, Chey WD, Saad RJ, Fenner DE (2013) Factors associated with symptom severity in women presenting with fecal incontinence. Dis Colon Rectum 56(1):97–102CrossRefPubMed

36.

O’Mahony F, Hofmeyr GJ, Menon V (2010) Choice of instruments for assisted vaginal delivery. Cochrane Database Syst Rev. 11:Cd005455

37.

Dietz HP (2015) Forceps: towards obsolescence or revival? Acta Obstet Gynecol Scand 94(4):347–351CrossRefPubMed

Title: Association between pelvic floor dysfunction, and clinical and ultrasonographic evaluation in primiparous women: a cross-sectional study
Authors: Glaucia Miranda Varella Pereira
Zilma Silveira Nogueira Reis
Beatriz Deoti e Silva Rodrigues
Kelly Cristine Lacerda Rodrigues Buzatti
Maria Cristina da Cruz
Marilene Vale de Castro Monteiro
Publication date: 01-08-2018
Publisher: Springer Berlin Heidelberg
Published in: Archives of Gynecology and Obstetrics / Issue 2/2018
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI: https://doi.org/10.1007/s00404-018-4811-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Association between pelvic floor dysfunction, and clinical and ultrasonographic evaluation in primiparous women: a cross-sectional study

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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