Lai Loi Lee

Prevalence of levator ani muscle injury in Chinese women after first delivery.

To assess the prevalence of levator ani muscle injury in Chinese women after their first delivery and investigate associated factors.

Symptoms, quality of life, and factors affecting women's treatment decisions regarding pelvic organ prolapse

Introduction and hypothesisWe performed an investigation of symptoms, quality of life (QOL), and factors affecting women’s treatment choice of pelvic organ prolapse (POP).MethodsThree hundred and eight women presenting with POP were assessed by Pelvic Floor Distress Inventory (PFDI), Pelvic Floor Impact Questionnaire (PFIQ), Short Form-36 (SF-36), Pelvic Organ Prolapse Quantification (POP-Q) system, and urodynamic studies. Treatment was arranged according to each woman’s preference after counseling. Factors affecting treatment choice were evaluated. Descriptive statistics, chi-square or Fisher exact test, analysis of variance (ANOVA) test, and logistic regression analysis were used.ResultsPatients had high prevalence of urinary, prolapse, and bowel symptoms. Their QOL was impaired, with Urinary Impact Questionnaire (UIQ) higher than the Pelvic Organ Prolapse Impact Questionnaire (POPIQ) score and lower SF-36 score compared with the population norm. Logistic regression analysis indicated that complication from vaginal pessary, urodynamic stress incontinence (USI), stage of prolapse, and Pelvic Organ Prolapse Distress Inventory (POPDI) scoring were factors for choosing surgical treatment.ConclusionsWomen with POP had great symptomatic distress and impaired QOL. Complication from vaginal pessary, USI, stage of prolapse, and POPDI scores were factors increasing the likelihood of the patient choosing surgical treatment.

Responsiveness of the Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaire in women undergoing treatment for pelvic floor disorders

Introduction and hypothesisThis study evaluated the responsiveness and minimal important differences (MID) of the Chinese Pelvic Floor Distress Inventory (PFDI) and Pelvic Floor Impact Questionnaire (PFIQ) in women undergoing urodynamic stress incontinence (USI) and/or pelvic organ prolapse (POP) treatment.MethodsOne hundred and fifty-six women were assessed using the PFDI and PFIQ before and after they received continence surgery and or pelvic floor repair (PFR) surgery, or vaginal pessary. Symptom severity was recorded using a visual analog scale (VAS) before and after treatment as was rating of their satisfaction with the treatment they received. Responsiveness of the PFDI and PFIQ were evaluated by effect sizes, standardized response mean, paired samples t test or Wilcoxon Signed Rank Test. MID in the PFDI and PFIQ for different treatments were determined by satisfaction rating, change in VAS scoring, and distribution-based methods.ResultsThere were significant improvements in the respective subscales of PFDI and PFIQ, demonstrating moderate to great responsiveness after different treatments. The estimation of MID for the Urinary Distress Inventory (UDI) was −30 to −14 and the Urinary Impact Questionnaire (UIQ) was −28 to −14 for women who underwent continence surgery. The MID for the Pelvic Organ Prolapse Distress Inventory (POPDI) was −44 to −21, the Pelvic Organ Prolapse Impact Questionnaire (POPIQ) −40 to −27, the UDI −22 to −16, the UIQ −37 to −31, the Colo-Rectal-Anal Distress Inventory (CRADI) −37 to −14, and the Colo-Rectal-Anal Impact Questionnaire (CRAIQ) −34 to −6 for women who underwent PFR surgery; and estimation of MID for the POPDI was −16, the POPIQ −29, the UDI −28, the UIQ −17, the CRADI −25, and the CRAIQ −31 for women who received a vaginal pessary. The MID of the respective subscales were supported by the distribution-based methods.ConclusionsThe Chinese PFDI and PFIQ instruments are responsive to change in women undergoing continence surgery, PFR surgery or vaginal pessary for USI or POP.

A longitudinal follow-up of levator ani muscle avulsion: does a second delivery affect it?

To evaluate the morphological outcome of levator ani muscle (LAM) avulsion 3–5 years after a first delivery and to assess the effect of a second delivery on this condition. The impact of LAM avulsion on pelvic floor disorders was also studied.

Levator ani muscle avulsion is a risk factor for expulsion within 1 year of vaginal pessary placed for pelvic organ prolapse

The aim of this study was to investigate whether the presence of levator ani muscle (LAM) avulsion is associated with expulsion within 1u2009year of a vaginal pessary placed for pelvic organ prolapse (POP).

OP34.07: Levator ani muscle injury after first delivery in Chinese primiparous women

Objectives: Vaginal delivery has been identified as risk on pelvic floor; 18–35% of Caucasian women having their first vaginal delivery were found with levator ani muscle injury (LAM). Variation in pelvic connective tissue quality was found between ethnicity. This study aims at examining the prevalence of LAM injury after vaginal delivery in primiparous Chinese women. Methods: Nulliparous Chinese women with singleton pregnancies were recruited. Trans-labial 3D-ultrasound at 35–38 weeks of gestation and 8 weeks post-delivery were performed at rest and at pelvic floor contraction. Demographic and delivery data were collected and the mode of delivery determined by Obstetric indications. Two investigators blinded to the information reviewed the volume data set and searched in its entirety of the continuity of the V-shape LAM. Defects were identified when a loss of continuity within the pubovisceral muscle was visualised. Results: 282 women completed the study, 219 (77.7%) had vaginal delivery including 42 vacuum extractions and 9 forceps; 63 (22.3%) had Caesarean sections (11 elective and 52 emergency). No LAM injury was found antenatally and in the postnatal Caesarean section group. 56 women (25.6%) had LAM injury after vaginal delivery (18 bilateral and 38 unilateral). Instrumental delivery and longer duration of second stage of labour were found statistically associated with LAM injury (Table 1). Conclusions: 25.6% of primiparous Chinese women had levator ani muscle injury after their first vaginal delivery.

An observational follow-up study on pelvic floor disorders to 3–5 years after delivery

Introduction and hypothesisThis study aimed to determine the prevalence of urinary incontinence (UI), fecal incontinence (FI), and pelvic organ prolapse (POP) 3–5 years after the first pregnancy and their associated risk factors.MethodsWe assessed 506 women using the Pelvic Floor Distress Inventory (PFDI) and the Pelvic Floor Impact Questionnaire (PFIQ). Maternal characteristics and obstetric data were analyzed using descriptive analysis, independent sample t test, chi-squared test, and logistic regression.ResultsThe prevalence of UI, FI, and POP, respectively, at a mean of 43xa0months after first delivery was 40.8, 6.6, and 10.2% following vaginal delivery (VD) and 22.7, 4.5, and 4.5% following cesarean section (CS). Stress urinary incontinence (SUI) was reported by more women following VD than CS (38.7 vs 22.4%, Pu2009=u20090.010). Compared with 8xa0weeks’ postpartum, more women reported SUI at this later follow-up visit (40.1 vs 19.5%, Pu2009<u20090.001), but fewer reported FI. More women who had an instrumental delivery reported symptoms of POP compared with those who had a normal VD. Higher body weight and weight gain from first trimester were risk factors of SUI [odds ratio (OR) 1.03] and urge urinary incontinence (UUI) (OR 1.18), respectively. Women who delivered vaginally had higher PFDI subscales scores.Conclusions VD increased UI risk. Higher body weight and weight gain from first trimester were risk factors for SUI and UUI, respectively. More women reported symptoms of POP following an instrumental delivery than those who had a normal VD.

P12.01: Pelvic floor biometry after the delivery in Chinese primiparous women

Results: Thirty-eight women were diagnosed of Cesaeran scar defect at TUS. The number of previous Caesarean sections in patients with uterine dehiscence and ectopic pregnancy in Cesarean scar is shown in Table 1. Eleven patients (29%) showed a uterine dehiscence. Seven cases were repaired by laparoscopy and 4 cases required hysterectomy. Five ectopic pregnancies (13%) were diagnosed at TUS. Two patients required hysterectomy, 2 were treated with local methotrexate guided by TUS and 1 was surgically sutured. Two patients (5%) had a complete uterine rupture. One of them diagnosed 6 months after Cesarean section and required hysterectomy. The other which was diagnosed during puerperium period was treated by surgical repair. Conclusions: TUS is useful for detecting Cesarean scar defects providing information for a treatment in case of complications.

OP13.02: Pelvic floor biometries during the first singleton pregnancy in Chinese nulliparous women

Objectives: This study aims at evaluating the pelvic floor biometries during the first pregnancy of Chinese nulliparous women. The relationship with pelvic floor symptoms was also explored. Methods: Nulliparous Chinese women with singleton pregnancies were recruited. They were assessed at 10–13 weeks, 26–28 weeks and 35–38 weeks of gestation. Trans-labial 3D-ultrasound was performed at rest, Valsalva maneuver (VM) and pelvic floor contraction (PFMC) during each visit. Stress urinary incontinence, urgency urinary incontinence and dragging discomfort were also asked during each visit. Offline analysis of USG volume data sets were done by an investigator blinded to the information. Position of the anterior compartment (bladder neck vertical position), middle compartment (most inferior part of cervix) and posterior compartment (ano-rectal junction) and the hiatal dimensions were measured in a standard way. Results: In all, data of 187 women were reported here. Their mean age was 30.4 ± 4.0 years. There were significant descent of all three compartments and enlargement of hiatal area during rest, VM or PFMC as the pregnancy advanced. At second and third trimester, 54 (29%) and 60 (32%) women reported stress urinary incontinence, but there was no association with the bladder neck mobility. And 41 (22%) and 60 (32%) reported symptoms of dragging sensation but there was no association with the hiatal area. Conclusions: There were significant changes of pelvic floor biometries with descent of three compartments at rest, at VM and PFMC as pregnancy advanced. Stress urinary incontinence and dragging sensation were common during pregnancy; however, both were not associated with parameters of pelvic floor biometries.