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Published in: International Urogynecology Journal 2/2009

01-02-2009 | Original Article

Magnetic resonance assessment of pelvic anatomy and pelvic floor disorders after childbirth

Authors: Victoria L. Handa, Mark E. Lockhart, Kimberly S. Kenton, Catherine S. Bradley, Julia R. Fielding, Geoffrey W. Cundiff, Caryl G. Salomon, Christiane Hakim, Wen Ye, Holly E. Richter

Published in: International Urogynecology Journal | Issue 2/2009

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Abstract

To compare pelvic anatomy, using magnetic resonance imaging, between postpartum women with or without pelvic floor disorders. We measured postpartum bony and soft tissue pelvic dimensions in 246 primiparas, 6–12-months postpartum. Anatomy was compared between women with and without urinary or fecal incontinence, or pelvic organ prolapse; P < 0.01 was considered statistically significant. A deeper sacral hollow was significantly associated with fecal incontinence (P = 0.005). Urinary incontinence was marginally associated with a wider intertuberous diameter (P = 0.017) and pelvic arch (P = 0.017). There were no significant differences in pelvimetry measures between women with and without prolapse (e.g., vaginal or cervical descent to or beyond the hymen). We did not detect meaningful differences in soft tissue dimensions for women with and without these pelvic floor disorders. Dimensions of the bony pelvis do not differ substantially between primiparous women with and without postpartum urinary incontinence, fecal incontinence and prolapse.
Literature
1.
go back to reference Koyama T, Togashi K (2007) Functional MR imaging of the female pelvis. J Magn Reson Imaging 25:1101–1112PubMedCrossRef Koyama T, Togashi K (2007) Functional MR imaging of the female pelvis. J Magn Reson Imaging 25:1101–1112PubMedCrossRef
2.
go back to reference Fielding JR (2002) Practical MR imaging of female pelvic floor weakness. Radiographics 22:295–304PubMed Fielding JR (2002) Practical MR imaging of female pelvic floor weakness. Radiographics 22:295–304PubMed
3.
go back to reference DeLancey JO, Morgan DM, Fenner DE et al (2007) Comparison of levator ani muscle defects and function in women with and without pelvic organ prolapse. Obstet Gynecol 109:295–302PubMed DeLancey JO, Morgan DM, Fenner DE et al (2007) Comparison of levator ani muscle defects and function in women with and without pelvic organ prolapse. Obstet Gynecol 109:295–302PubMed
4.
go back to reference Healy JC, Halligan S, Reznek RH, Watson S, Phillips RK, Armstrong P (1997) Patterns of prolapse in women with symptoms of pelvic floor weakness: assessment with MR imaging. Radiology 203:77–81PubMed Healy JC, Halligan S, Reznek RH, Watson S, Phillips RK, Armstrong P (1997) Patterns of prolapse in women with symptoms of pelvic floor weakness: assessment with MR imaging. Radiology 203:77–81PubMed
5.
go back to reference Hoyte L, Jakab M, Warfield SK, Shott S, Flesh G, Fielding JR (2004) Levator ani thickness variations in symptomatic and asymptomatic women using magnetic resonance-based 3-dimensional color mapping. Am J Obstet Gynecol 191:856–861PubMedCrossRef Hoyte L, Jakab M, Warfield SK, Shott S, Flesh G, Fielding JR (2004) Levator ani thickness variations in symptomatic and asymptomatic women using magnetic resonance-based 3-dimensional color mapping. Am J Obstet Gynecol 191:856–861PubMedCrossRef
6.
go back to reference Kaufman HS, Buller JL, Thompson JR et al (2001) Dynamic pelvic magnetic resonance imaging and cystocolpoproctography alter surgical management of pelvic floor disorders. Dis Colon Rectum 44:1575–1583 discussion 83–4PubMedCrossRef Kaufman HS, Buller JL, Thompson JR et al (2001) Dynamic pelvic magnetic resonance imaging and cystocolpoproctography alter surgical management of pelvic floor disorders. Dis Colon Rectum 44:1575–1583 discussion 83–4PubMedCrossRef
7.
go back to reference Kelvin FM, Maglinte DD, Hale DS, Benson JT (2000) Female pelvic organ prolapse: a comparison of triphasic dynamic MR imaging and triphasic fluoroscopic cystocolpoproctography. AJR Am J Roentgenol 174:81–88PubMed Kelvin FM, Maglinte DD, Hale DS, Benson JT (2000) Female pelvic organ prolapse: a comparison of triphasic dynamic MR imaging and triphasic fluoroscopic cystocolpoproctography. AJR Am J Roentgenol 174:81–88PubMed
8.
go back to reference Frudinger A, Halligan S, Spencer JA, Bartram CI, Kamm MA, Winter R (2002) Influence of the subpubic arch angle on anal sphincter trauma and anal incontinence following childbirth. Bjog 109:1207–1212PubMed Frudinger A, Halligan S, Spencer JA, Bartram CI, Kamm MA, Winter R (2002) Influence of the subpubic arch angle on anal sphincter trauma and anal incontinence following childbirth. Bjog 109:1207–1212PubMed
9.
go back to reference Handa VL, Pannu HK, Siddique S, Gutman R, VanRooyen J, Cundiff G (2003) Architectural differences in the bony pelvis of women with and without pelvic floor disorders. Obstet Gynecol 102:1283–1290PubMedCrossRef Handa VL, Pannu HK, Siddique S, Gutman R, VanRooyen J, Cundiff G (2003) Architectural differences in the bony pelvis of women with and without pelvic floor disorders. Obstet Gynecol 102:1283–1290PubMedCrossRef
10.
go back to reference Stav K, Alcalay M, Peleg S, Lindner A, Gayer G, Hershkovitz I (2007) Pelvis architecture and urinary incontinence in women. Eur Urol 52:239–244PubMedCrossRef Stav K, Alcalay M, Peleg S, Lindner A, Gayer G, Hershkovitz I (2007) Pelvis architecture and urinary incontinence in women. Eur Urol 52:239–244PubMedCrossRef
11.
go back to reference Sze EH, Kohli N, Miklos JR, Roat T, Karram MM (1999) Computed tomography comparison of bony pelvis dimensions between women with and without genital prolapse. Obstet Gynecol 93:229–232PubMedCrossRef Sze EH, Kohli N, Miklos JR, Roat T, Karram MM (1999) Computed tomography comparison of bony pelvis dimensions between women with and without genital prolapse. Obstet Gynecol 93:229–232PubMedCrossRef
12.
go back to reference Zaretsky MV, Alexander JM, McIntire DD, Hatab MR, Twickler DM, Leveno KJ (2005) Magnetic resonance imaging pelvimetry and the prediction of labor dystocia. Obstet Gynecol 106:919–926PubMed Zaretsky MV, Alexander JM, McIntire DD, Hatab MR, Twickler DM, Leveno KJ (2005) Magnetic resonance imaging pelvimetry and the prediction of labor dystocia. Obstet Gynecol 106:919–926PubMed
13.
go back to reference Borello-France D, Burgio KL, Richter HE et al (2006) Fecal and urinary incontinence in primiparous women. Obstet Gynecol 108:863–872PubMedCrossRef Borello-France D, Burgio KL, Richter HE et al (2006) Fecal and urinary incontinence in primiparous women. Obstet Gynecol 108:863–872PubMedCrossRef
14.
go back to reference Richter HE, Fielding JR, Bradley CS et al (2006) Endoanal ultrasound findings and fecal incontinence symptoms in women with and without recognized anal sphincter tears. Obstet Gynecol 108:1394–401PubMed Richter HE, Fielding JR, Bradley CS et al (2006) Endoanal ultrasound findings and fecal incontinence symptoms in women with and without recognized anal sphincter tears. Obstet Gynecol 108:1394–401PubMed
15.
go back to reference Bump RC, Mattiasson A, Bo K et al (1996) The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 175:10–17PubMedCrossRef Bump RC, Mattiasson A, Bo K et al (1996) The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 175:10–17PubMedCrossRef
16.
go back to reference Diokno AC, Brock BM, Brown MB, Herzog AR (1986) Prevalence of urinary incontinence and other urological symptoms in the noninstitutionalized elderly. J Urol 136:1022–1025PubMed Diokno AC, Brock BM, Brown MB, Herzog AR (1986) Prevalence of urinary incontinence and other urological symptoms in the noninstitutionalized elderly. J Urol 136:1022–1025PubMed
17.
go back to reference Herzog AR, Diokno AC, Fultz NH (1989) Urinary incontinence: medical and psychosocial aspects. Annu Rev Gerontol Geriatr 9:74–119PubMed Herzog AR, Diokno AC, Fultz NH (1989) Urinary incontinence: medical and psychosocial aspects. Annu Rev Gerontol Geriatr 9:74–119PubMed
18.
go back to reference Rockwood TH, Church JM, Fleshman JW et al (1999) Patient and surgeon ranking of the severity of symptoms associated with fecal incontinence: the fecal incontinence severity index. Dis Colon Rectum 42:1525–1532PubMedCrossRef Rockwood TH, Church JM, Fleshman JW et al (1999) Patient and surgeon ranking of the severity of symptoms associated with fecal incontinence: the fecal incontinence severity index. Dis Colon Rectum 42:1525–1532PubMedCrossRef
19.
go back to reference Bradley CS, Zimmerman MB, Qi Y, Nygaard IE (2007) Natural history of pelvic organ prolapse in postmenopausal women. Obstet Gynecol 109:848–854PubMed Bradley CS, Zimmerman MB, Qi Y, Nygaard IE (2007) Natural history of pelvic organ prolapse in postmenopausal women. Obstet Gynecol 109:848–854PubMed
20.
go back to reference Lukacz ES, Whitcomb EL, Lawrence JM, Nager CW, Contreras R, Luber KM (2007) Are sexual activity and satisfaction affected by pelvic floor disorders? Analysis of a community-based survey. Am J Obstet Gynecol 197(88):e1–6 Lukacz ES, Whitcomb EL, Lawrence JM, Nager CW, Contreras R, Luber KM (2007) Are sexual activity and satisfaction affected by pelvic floor disorders? Analysis of a community-based survey. Am J Obstet Gynecol 197(88):e1–6
21.
go back to reference Trowbridge ER, Fultz NH, Patel DA, DeLancey JO, Fenner DE (2008) Distribution of pelvic organ support measures in a population-based sample of middle-aged, community-dwelling African American and white women in southeastern Michigan. Am J Obstet Gynecol 198(548):e1–6PubMed Trowbridge ER, Fultz NH, Patel DA, DeLancey JO, Fenner DE (2008) Distribution of pelvic organ support measures in a population-based sample of middle-aged, community-dwelling African American and white women in southeastern Michigan. Am J Obstet Gynecol 198(548):e1–6PubMed
22.
go back to reference Hoyte L, Schierlitz L, Zou K, Flesh G, Fielding JR (2001) Two- and 3-dimensional MRI comparison of levator ani structure, volume, and integrity in women with stress incontinence and prolapse. Am J Obstet Gynecol 185:11–19PubMedCrossRef Hoyte L, Schierlitz L, Zou K, Flesh G, Fielding JR (2001) Two- and 3-dimensional MRI comparison of levator ani structure, volume, and integrity in women with stress incontinence and prolapse. Am J Obstet Gynecol 185:11–19PubMedCrossRef
23.
go back to reference Hodroff MA, Stolpen AH, Denson MA, Bolinger L, Kreder KJ (2002) Dynamic magnetic resonance imaging of the female pelvis: the relationship with the Pelvic Organ Prolapse quantification staging system. J Urol 167:1353–1355PubMedCrossRef Hodroff MA, Stolpen AH, Denson MA, Bolinger L, Kreder KJ (2002) Dynamic magnetic resonance imaging of the female pelvis: the relationship with the Pelvic Organ Prolapse quantification staging system. J Urol 167:1353–1355PubMedCrossRef
24.
go back to reference Etlik O, Arslan H, Odabasi O et al (2005) The role of the MR-fluoroscopy in the diagnosis and staging of the pelvic organ prolapse. Eur J Radiol 53:136–141PubMedCrossRef Etlik O, Arslan H, Odabasi O et al (2005) The role of the MR-fluoroscopy in the diagnosis and staging of the pelvic organ prolapse. Eur J Radiol 53:136–141PubMedCrossRef
25.
go back to reference Steyn M, Pretorius E, Hutten L (2004) Geometric morphometric analysis of the greater sciatic notch in South Africans. Homo 54:197–206PubMedCrossRef Steyn M, Pretorius E, Hutten L (2004) Geometric morphometric analysis of the greater sciatic notch in South Africans. Homo 54:197–206PubMedCrossRef
26.
go back to reference Lockhart ME, Fielding JR, Richter HE, Brubaker L, Salomon CG, Ye W, Hakim CM, Wai CY, Stolpen A, Weber AM (2008) Reproducibility of dynamic MRI pelvic measures: a multi-site study. Radiology, in press Lockhart ME, Fielding JR, Richter HE, Brubaker L, Salomon CG, Ye W, Hakim CM, Wai CY, Stolpen A, Weber AM (2008) Reproducibility of dynamic MRI pelvic measures: a multi-site study. Radiology, in press
Metadata
Title
Magnetic resonance assessment of pelvic anatomy and pelvic floor disorders after childbirth
Authors
Victoria L. Handa
Mark E. Lockhart
Kimberly S. Kenton
Catherine S. Bradley
Julia R. Fielding
Geoffrey W. Cundiff
Caryl G. Salomon
Christiane Hakim
Wen Ye
Holly E. Richter
Publication date
01-02-2009
Publisher
Springer-Verlag
Published in
International Urogynecology Journal / Issue 2/2009
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI
https://doi.org/10.1007/s00192-008-0736-2

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