Study of levator ani anatomy and function using dynamic 4D ultrasound after vaginal versus caesarean delivery in primiparous women.

Gamal Elsayed Abdelmoamen Elsayed Fares; Mervat Sheikh El-Arab Elsedeek; Ahmed Mostafa Fouad; Engy Mohamed Taher

Gamal Elsayed Abdelmoamen Elsayed Fares Assistant lecturer, Department of Obstetrics and Gynecology, Faculty of Medicine , Alexandria University , Egypt
Mervat Sheikh El-Arab Elsedeek, Professor of Obstetrics and Gynaecology Faculty Of Medicine, Alexandria University
Ahmed Mostafa Fouad, Assistant Professor of OB/GYN Faculty Of Medicine, Alexandria University
Engy Mohamed Taher, Professor of Obstetrics and Gynaecology

Abstract

Background: Childbirth is a central experience in women’s lives. Vaginal delivery is more physiological having superior outcome compared to caesarean section (CS). It is obvious that clinical assessment alone is insufficient to assess pelvic floor function and anatomy as it focuses on the description of surface anatomy which is unable to reveal true underlying abnormalities, therefore the role of pelvic floor ultrasound imaging is increasing in postnatal follow up visits. Non-invasive nature of pelvic floor ultrasound allows a comprehensive pelvic floor assessment, enabling a new dimension in obstetric quality control and secondary prevention of pelvic floor dysfunctions. This study was conducted to assess pelvic floor function using four dimensional (4D) dynamic ultrasound in a cohort of women after vaginal versus caesarean delivery and the ultimate objective was to predict the impact of vaginal delivery on pelvic floor function and also to study the potential of 4D ultrasound in assessment of pelvic floor dysfunction. Methods: This study was a cross-sectional study conducted on 120 primiparous women 2-3 months after delivery. Women were recruited after counselling from urogynaecology, family planning clinic and ultrasound unit in El-Shatby Maternity Hospital, after approval of the local Ethical Committee and having an informed consent from patients included in the study. Results: We found no statistically significant differences between the primiparous after vaginal and caesarean delivery regarding levator ani anatomy and functions parameters at rest. During Valsalva, there was significant increase in levator ani hiatus anteroposterior, transverse diameter and levator ani hiatus area, yet they did not exceed upper limit normal range. Conclusions: There is no significant differences between vaginal versus caesarean delivery on levator ani functions at rest yet statistically significant differences in certain parameters at Valsalva without exceeding the normal range.