Franziska Siafarikas

Learning process for performing and analyzing 3D/4D transperineal ultrasound imaging and interobserver reliability study

To evaluate the learning process for acquiring three‐ and four‐dimensional (3D/4D) transperineal ultrasound volumes of the levator hiatus (LH) dimensions at rest, during pelvic floor muscle (PFM) contraction and on Valsalva maneuver, and for analyzing the ultrasound volumes, as well as to perform an interobserver reliability study between two independent ultrasound examiners.

Postpartum pelvic floor muscle training and urinary incontinence: a randomized controlled trial.

OBJECTIVE: To evaluate whether postpartum pelvic floor muscle training decrease prevalence of any urinary incontinence (UI) in primiparous women with and without UI at inclusion (mixed population) and further to perform stratified analyses on women with and without major levator ani muscle defects. METHODS: A two-armed assessor-blinded randomized controlled trial including primiparous women 6 weeks after vaginal delivery was conducted. Participants were stratified on major levator ani muscle defects, verified by transperineal ultrasonography, and thereafter randomly allocated to training or control. All participants were taught to contract the pelvic floor muscles. The control participants received no further intervention, whereas training participants attended a weekly supervised pelvic floor muscle training class and performed daily home exercise for 16 weeks. Primary outcome was self-reported UI analyzed by relative risk. RESULTS: We included 175 women, 55 with major levator ani muscle defects and 120 without. Prevalence of UI at baseline was 39.1% in the training group (n=87) and 50% among those in the control group (n=88). Fifteen women (8.6%) were lost to follow-up. At 6 months after delivery (postintervention), 34.5% and 38.6% reported UI in the training and control groups, respectively. Relative risk analysis of UI gave a nonsignificant effect size of 0.89 (95% confidence interval [CI] 0.60–1.32). Results were similar for the stratum with and without major levator ani muscle defects, 0.89 (95% CI 0.51–1.56) and 0.90 (95% CI 0.53–1.52), respectively. CONCLUSIONS: Postpartum pelvic floor training did not decrease UI prevalence 6 months after delivery in primiparous women. Stratified analysis on women with and without major levator ani muscle defects showed similar nonsignificant results. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT01069484. LEVEL OF EVIDENCE: I

Impact of childbirth and mode of delivery on vaginal resting pressure and on pelvic floor muscle strength and endurance.

OBJECTIVE We sought to study impact of delivery mode on vaginal resting pressure (VRP) and on pelvic floor muscle (PFM) strength and endurance, and whether these measurements differed in women with and without urinary incontinence. STUDY DESIGN We conducted a cohort study following 277 nulliparous women from midpregnancy to 6 weeks postpartum. Manometer was used for PFM measurements; differences were analyzed by t test (within groups) and analysis of variance (between groups). RESULTS Only VRP changed significantly (10% reduction, P = .001) after emergency cesarean section. After normal and instrumental vaginal delivery, VRP was reduced by 29% and 30%; PFM strength by 54% and 66%; and endurance by 53% and 65%, respectively. Significant differences for all PFM measures (P < .001) were found when comparing cesarean vs normal and instrumental vaginal delivery, respectively. Urinary continent women at both time points had significantly higher PFM strength and endurance than incontinent counterparts (P < .05). CONCLUSION Pronounced reductions in VRP and in PFM strength and endurance were found after vaginal delivery. Continent women were stronger than incontinent counterparts.

Postpartum recovery of levator hiatus and bladder neck mobility in relation to pregnancy.

OBJECTIVE: To study postpartum changes in pelvic floor morphology in a cohort of primiparous women. METHODS: Transperineal ultrasound measurements taken at five examination points, both prepartum and postpartum, provided data for comparison. Three hundred nulliparous pregnant women were examined at 21 weeks of gestation and 274 (91%) at 37 weeks of gestation. At 6 weeks postpartum, 285 (95%) women were examined, 198 (66%) at 6 months, and 178 (59%) at 12 months using transperineal ultrasonography at rest, during contraction, and during Valsalva maneuver. The levator hiatus area, bladder neck mobility, and rest-to-Valsalva hiatal area difference were assessed. RESULTS: Approximately 85% had vaginal and 15% had cesarean deliveries. Demographic characteristics of the patients lost to follow-up were similar to the patients not lost to follow-up. In the vaginal group, a significant decrease in all measurements was seen during the first 6 months postpartum, being most pronounced for the levator hiatus area during Valsalva maneuver (−3.5 cm2; P<.001). In the cesarean delivery group, no significant changes between examination points were found postpartum. Only the vaginal delivery group showed significant increases in all measurements when comparing the status at 12 months postpartum with 21 weeks of gestation, most pronounced for levator hiatus area during Valsalva maneuver (3 cm2; P<.001). However, comparing the two delivery groups at 12 months postpartum, the only significant difference found was levator hiatus area during contraction. CONCLUSION: The levator ani muscle has the ability to recover after pregnancy and delivery, although not all women recover to pregnancy level. Most of the recovery occurs during the first 6 months postpartum. Significant pregnancy-induced changes are not shown to persist 1 year postpartum. LEVEL OF EVIDENCE: II

Pelvic floor muscle injuries 6 weeks post partum-an intra- and inter-rater study.

To evaluate intra‐ and inter‐rater reliability when diagnosing major defects, and inter‐rater reliability of diagnosing minor defects and muscle thickness of the pubovisceral muscle in primiparous women 6 weeks after vaginal delivery, using 3D/4D transperineal ultrasound.

The levator ani muscle during pregnancy and major levator ani muscle defects diagnosed postpartum: a three- and four-dimensional transperineal ultrasound study

To investigate associations between levator hiatus area and levator ani muscle function during pregnancy and major levator ani muscle defects postpartum.

Effect of postpartum pelvic floor muscle training on vaginal symptoms and sexual dysfunction—secondary analysis of a randomised trial

Evaluate effect of pelvic floor muscle training (PFMT) on vaginal symptoms and sexual matters, dyspareunia and coital incontinence in primiparous women stratified by major or no defects of the levator ani muscle.

Levator hiatus dimensions in late pregnancy and the process of labor: a 3- and 4-dimensional transperineal ultrasound study.

OBJECTIVE The objectives of the investigation were to study the association between levator hiatus dimensions in late pregnancy and both the length of second stage of labor and also the delivery mode in women delivering their first child. STUDY DESIGN In this cohort study, 231 nulliparous women were examined with 3- and 4-dimensional transperineal ultrasonography at 37 weeks of gestation. The anteroposterior, transverse diameter, and the area of levator hiatus were measured at rest, during levator ani muscle contraction, and during Valsalva maneuver. The second stage of labor was divided into passive and active second stage and delivery modes into normal vaginal or instrumental deliveries. Spearman correlation coefficient, independent-sample t test, and standard logistic regression were used for analysis. RESULTS Larger levator hiatus dimensions at rest and during contraction at 37 weeks of gestation correlated with a shorter duration of the active second stage in women with normal vaginal delivery (Spearman correlation coefficient, -0.13 to -0.35, P ≤ .08). Women having normal vaginal deliveries had significantly larger transverse diameter at rest, during contraction, and during Valsalva maneuver compared with women having instrumental deliveries (mean difference, 0.29; 95% confidence interval (CI), 0.16-0.41; mean difference, 0.33; 95% CI, 0.21-0.44 and mean difference, 0.24; 95% CI, 0.06-0.42; P < .05). The same was true for the levator hiatus area at rest and during contraction (mean difference, 1.22; 95% CI, 0.37-2.07 and mean difference, 0.84; 95% CI, 0.22-1.46; P < .01). These estimates were unchanged by adjustments in the logistic regression analysis. CONCLUSION Larger levator hiatus dimensions in late pregnancy had a significant association with a shorter active second stage of labor and normal vaginal delivery.

Does general exercise training before and during pregnancy influence the pelvic floor “opening” and delivery outcome? A 3D/4D ultrasound study following nulliparous pregnant women from mid-pregnancy to childbirth

Background It has been suggested that women who are regular exercisers have a tighter pelvic floor and thereby have more difficulty during childbirth than non-exercising women. We investigated whether women exercising before and during pregnancy have a narrower levator hiatus (LH) area than their sedentary counterparts. We also studied whether regular exercise at gestational week 37 influences delivery outcome. Methods Cohort study of 274 nulliparous pregnant women assessed at mid-pregnancy and gestational week 37 by three-dimensional/four-dimensional transperineal ultrasonography of the LH area. Exercisers were defined as those exercising ≥30 min three times per week and non-exercisers as not exercising. Exercise data were collected via electronic questionnaire at mean gestational weeks 21 and 37. Labour and delivery outcomes were collected from the womens electronic medical birth records. Differences between exercisers and non-exercisers were analysed using independent sample t test or χ2 test. p Value was set to ≤0.05. Results At gestational week 37, exercisers had a significantly larger LH area than non-exercisers at rest and during PFM contraction (mean difference −1.6 cm2 (95% CI −3.0 to −0.3), p=0.02 and −1.1 cm2 (95% CI −2.0 to −0.1), p=0.04, respectively). No significant differences were found between exercisers and non-exercisers at week 37 in any labour or delivery outcomes. Conclusions The results of the present study do not support the hypothesis that women exercising regularly before or during pregnancy have a narrower LH area or more complicated childbirths than non-exercising women. Trial registration number ClinicalTrials.gov: NCT01045135.

Change in pelvic organ support during pregnancy and the first year postpartum: a longitudinal study

To describe changes in pelvic organ support from mid pregnancy until 1 year postpartum among nulliparous pregnant women, and to examine whether delivery route affects changes in pelvic organ support.