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Pelvic floor biometry during a first singleton pregnancy and the relationship with symptoms of pelvic floor disorders: a prospective observational study
Author(s) -
Chan SSC,
Cheung RYK,
Yiu KW,
Lee LL,
Leung TY,
Chung TKH
Publication year - 2014
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.12400
Subject(s) - medicine , pelvic floor , pregnancy , obstetrics , urinary incontinence , observational study , prospective cohort study , gynecology , valsalva maneuver , population , vaginal delivery , pelvic floor dysfunction , surgery , genetics , environmental health , blood pressure , biology
Objective To assess pelvic floor biometry during pregnancy and the correlation with symptoms of pelvic floor disorders in women. Design A prospective observational study. Setting Antenatal clinic between A ugust 2009 and M ay 2011. Population Nulliparous women in their first pregnancy. Methods Pelvic floor was assessed by translabial ultrasound and symptoms of pelvic floor disorders were explored with a standardised questionnaire at each trimester. Main outcome measures Pelvic floor biometry during pregnancy. Results A total of 405 (91.6%) women completed the study. As the pregnancy advanced, there was significant descent of the bladder neck ( BN ), cervix, and anorectal junction. The hiatal area ( HA ) was significantly enlarged, with a mean increase of 15.1 ± 24.8% at rest, and 24.7 ± 28.5% at Valsalva, at third trimester when compared with first trimester. Risk factors for stress urinary incontinence ( SUI ) were: descent of BN at V alsalva ( OR 3.2, 95% CI 1.2–8.5), increase in HA at pelvic floor contraction ( PFMC ; OR 1.3, 95% CI 1.0–1.6), and increase in maternal age ( OR 1.1, 95% CI 1.0–1.2), at first trimester; increase in HA at PFMC ( OR 1.3, 95% CI 1.1–1.5) at second trimester; and descent of BN at rest ( OR 2.3, 95% CI 1.1–4.9) and increase in maternal age ( OR 1.1, 95% CI 1.02–1.2) at third trimester. Descent of anorectal junction ( OR 1.5, 95% CI 1.1–1.9) and increase in HA at rest ( OR 1.2, 95% CI 1.0–1.3) were factors for prolapse symptoms at second and third trimester, respectively. Conclusions Pelvic floor changes begin during pregnancy. There was significant descent of the BN , cervix, and anorectal junction, and enlargement of the hiatal area, as the pregnancy advanced. SUI was associated with descent of the BN , and prolapse symptoms were associated with an increase in the hiatal area.