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International Urogynecology Journal

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Open Access 01-07-2021 | Perineal Laceration | Original Article

An ultrasound observation study on the levator hiatus with or without diastasis recti abdominis in postpartum women

Authors: Peng Tian, Dong Mei Liu, Chao Wang, Yu Gu, Guo Qing Du, Jia Wei Tian

Published in: International Urogynecology Journal | Issue 7/2021

Abstract

Introduction and hypothesis

We hypothesized that differences in post-partum levator hiatus (LH) measurements, as well as the area of urethra and bladder (AUB), viewed under ultrasound, correlate with diastasis rectus abdominis (DRA) occurrence. The primary objective of this study is to determine ultrasound parameters available for diagnosing DRA in post-partum women. We compared LH and AUB measurements under ultrasound in primiparous women, with and without DRA, at 24–26 weeks postpartum.

Methods

One hundred ninety-four women underwent routine examination, including a self-made clinical symptoms questionnaire, DRA evaluation, and LH and AUB measurements. Independent samples t- and chi-squared tests were used to compare the differences between women with and without DRA.

Results

DRA incidence was significantly higher among those who underwent cesarean section (CS) than for vaginal delivery (VD) (P = 0.038). DRA patients could potentially have urinary urgency, frequency, pain, dysuria, and perineal tears. Additionally, statistically significant differences were found between VD patients, with or without DRA, in the resting LH transverse diameter (TrD) (P = 0.032) and the area of the levator hiatus (ALH) (P = 0.048) as well as AUB at Valsalva (P = 0.049). No differences, however, were found between the DRA and no DRA groups for all those measurements among women who had cesarean deliveries.

Conclusions

DRA was more likely in post-CS women. Furthermore, the results showed a plausible association between DRA occurrence and LH expansion, especially in women with VD under rest and Valsalva. This could be useful for developing therapeutic plans based on these parameters for post-partum rehabilitation of women with DRA to avoid long-term complications.

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Spitznagle TM, Leong FC, Van Dillen LR. Prevalence of diastasis recti abdominis in a urogynecological patient population. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18(3):321–8. https://doi.org/10.1007/s00192-006-0143-5.CrossRefPubMed

Gitta S, Magyar Z, Tardi P, et al. Prevalence, potential risk factors and sequelae of diastasis recti abdominis. Orv Hetil. 2017;158(12):454–60. https://doi.org/10.1556/650.2017.30703.CrossRefPubMed

Bo K, Hilde G, Tennfjord MK, Sperstad JB, Engh ME. Pelvic floor muscle function, pelvic floor dysfunction and diastasis recti abdominis: prospective cohort study. Neurourol Urodyn. 2017;36(3):716–21. https://doi.org/10.1002/nau.23005.CrossRefPubMed

Sperstad JB, Tennfjord MK, Hilde G, Ellstrom-Engh M, Bo K. Diastasis recti abdominis during pregnancy and 12 months after childbirth: prevalence, risk factors and report of lumbopelvic pain. Br J Sports Med. 2016;50(17):1092–6. https://doi.org/10.1136/bjsports-2016-096065.CrossRefPubMed

Fernandes da Mota PG, Pascoal AG, Carita AI, Bo K. Prevalence and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship with lumbo-pelvic pain. Man Ther. 2015;20(1):200–5. https://doi.org/10.1016/j.math.2014.09.002.CrossRefPubMed

Mota P, Pascoal AG, Sancho F, Bo K. Test-retest and intrarater reliability of 2-dimensional ultrasound measurements of distance between rectus abdominis in women. J Orthop Sports Phys Ther. 2012;42(11):940–6. https://doi.org/10.2519/jospt.2012.4115.CrossRefPubMed

Mota P, Pascoal AG, Sancho F, Carita AI, Bo K. Reliability of the inter-rectus distance measured by palpation. Comparison of palpation and ultrasound measurements. Man Ther. 2013;18(4):294–8. https://doi.org/10.1016/j.math.2012.10.013.CrossRefPubMed

van de Water AT, Benjamin DR. Measurement methods to assess diastasis of the rectus abdominis muscle (DRAM): a systematic review of their measurement properties and meta-analytic reliability generalisation. Man Ther. 2016;21:41–53. https://doi.org/10.1016/j.math.2015.09.013.CrossRefPubMed

Toozs-Hobson P, Balmforth J, Cardozo L, Khullar V, Athanasiou S. The effect of mode of delivery on pelvic floor functional anatomy. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(3):407–16. https://doi.org/10.1007/s00192-007-0455-0.CrossRefPubMed

10.

Wang Q, Yu X, Chen G, Sun X, Wang J. Does diastasis recti abdominis weaken pelvic floor function? A cross-sectional study. Int Urogynecol J. 2019;31(2):277–83. https://doi.org/10.1007/s00192-019-04005-9.CrossRefPubMed

11.

Mulder FE, Shek KL, Dietz HP. What’s a proper push? The Valsalva manoeuvre revisited. Aust N Z J Obstet Gynaecol. 2012;52(3):282–5. https://doi.org/10.1111/j.1479-828X.2012.01446.x.CrossRefPubMed

12.

Machin D, Campbell M, Fayers P, Pinol A. Sample size tables for clinical studies. 2nd edition. Malden: Blackwell Science; 1997.

13.

Zar HJ. Biostatistical analysis. Second edition edn. Englewood Cliffs: Prentice-Hall; 1984.

14.

Al-Sunduqchi (1990) Determining the Appropriate Sample Size for Inferences Based on the Wilcoxon Statistics. Dissertation, University of Wyoming.

15.

Mota P, Pascoal AG, Carita AI, Bo K. Normal width of the inter-recti distance in pregnant and postpartum primiparous women. Musculoskelet Sci Pract. 2018;35:34–7. https://doi.org/10.1016/j.msksp.2018.02.004.CrossRefPubMed

16.

Reinpold W, Kockerling F, Bittner R, et al. Classification of rectus diastasis-a proposal by the German Hernia Society (DHG) and the International Endohernia Society (IEHS). Front Surg. 2019;6(1):10.3389/fsurg.2019.00001.

17.

Beer GM, Schuster A, Seifert B, et al. The normal width of the linea alba in nulliparous women. Clin Anat. 2009;22(6):706–11. https://doi.org/10.1002/ca.20836.CrossRefPubMed

18.

Dalinjong PA, Laar AS. The national health insurance scheme: perceptions and experiences of health care providers and clients in two districts of Ghana. Health Economics Rev. 2012;2:13. https://doi.org/10.1186/2191-1991-2-13.CrossRef

19.

Dietz HP, Rojas RG, Shek KL. Postprocessing of pelvic floor ultrasound data: how repeatable is it? Aust N Z J Obstet Gynaecol. 2014;54(6):553–7. https://doi.org/10.1111/ajo.12250.CrossRefPubMed

20.

Haylen BT, Maher CF, Barber MD, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic organ prolapse (POP). Int Urogynecol J. 2016;27(4):655–84. https://doi.org/10.1007/s00192-016-3003-y.CrossRefPubMed

21.

Braekken IH, Majida M, Ellstrom-Engh M, et al. Test-retest and intra-observer repeatability of two-, three- and four-dimensional perineal ultrasound of pelvic floor muscle anatomy and function. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(2):227–35. https://doi.org/10.1007/s00192-007-0408-7.CrossRefPubMed

22.

Wilson PD, Herbison RM, Herbison GP. Obstetric practice and the prevalence of urinary incontinence three months after delivery. Br J Obstet Gynaecol. 1996;103(2):154–61. https://doi.org/10.1111/j.1471-0528.1996.tb09668.x.CrossRefPubMed

23.

Theodorsen NM, Strand LI, Bo K. Effect of pelvic floor and transversus abdominis muscle contraction on inter-rectus distance in postpartum women: a cross-sectional experimental study. Physiotherapy. 2018. https://doi.org/10.1016/j.physio.2018.08.009.

24.

Boissonnault JS, Blaschak MJ. Incidence of diastasis recti abdominis during the childbearing year. Phys Ther. 1988;68(7):1082–6. https://doi.org/10.1093/ptj/68.7.1082.CrossRefPubMed

25.

Ngunyi YL, Halle-Ekane G, Tendongfor N et al. Determinants and aetiologies of postpartum pyrexia; a retrospective analysis in a tertiary health facility in the Littoral Region of Cameroon. BMC Pregnancy and Childbirth.2020; 20 (1).https://doi.org/10.1186/s12884-020-02867-2.

26.

Wu Y, Dabhoiwala NF, Hagoort J, et al. Architectural differences in the anterior and middle compartments of the pelvic floor of young-adult and postmenopausal females. J Anat. 2017;230(5):651–63. https://doi.org/10.1111/joa.12598.CrossRefPubMedPubMedCentral

27.

Beamish N, Green N, Nieuwold E, McLean L. differences in linea alba stiffness and linea alba distortion between women with and without diastasis recti abdominis: the impact of measurement site and task. J Orthop Sports Phys Ther. 2019:1–30.https://doi.org/10.2519/jospt.2019.8543

Title: An ultrasound observation study on the levator hiatus with or without diastasis recti abdominis in postpartum women
Authors: Peng Tian
Dong Mei Liu
Chao Wang
Yu Gu
Guo Qing Du
Jia Wei Tian
Publication date: 01-07-2021
Publisher: Springer International Publishing
Keywords: Perineal Laceration
Ultrasound
Sectio Ceasarea
Ultrasound
Diastasis Recti
Sectio Caesarea
Published in: International Urogynecology Journal / Issue 7/2021
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-021-04783-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

An ultrasound observation study on the levator hiatus with or without diastasis recti abdominis in postpartum women

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

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