Krankenhaus Barmherzige Brüder - Frauenklinik St. Hedwig, Department of Obstetrics and Gynecology, University of Regensburg/Germany, Regensburg, Germany.
Ultrasound Obstet Gynecol. 2013 Feb;41(2):204-9. doi: 10.1002/uog.11214.
Three-dimensional (3D) transperineal ultrasound has been shown to be a reliable and reproducible method for visualization of morphological changes in the female levator ani muscle. The aim of this study was to evaluate the relationship between persisting pelvic floor disorders 18-24 months after first delivery, biometric measurements of the pelvic floor and mode of delivery.
In this prospective observational study, we recruited on their second day after delivery 130 primiparous women. All were Caucasian and their pregnancies had been singleton with cephalic presentation. 3D transperineal ultrasound was performed, with standardized settings, on the second day (results published previously) and 18-24 months after delivery. Volumes were obtained at rest and on Valsalva maneuver and biometric measurements of the levator hiatus were determined in the axial plane. Obstetric and constitutional parameters were obtained from our clinical files and, 18-24 months after the delivery, a standardized questionnaire was used to evaluate persisting pelvic floor disorders. Ultrasound measurements at 18-24 months were compared according to clinical symptoms of pelvic floor disorders and mode of delivery, including a subgroup analysis of vaginal (spontaneous vs operative vaginal) and Cesarean (primary i.e. elective vs secondary i.e. after onset of labor) delivery groups.
Seventy-seven (59%) women had complete follow-up at 18-24 months. Biometric measurements showed a significantly larger hiatal area in the vaginal delivery group than in the Cesarean section group 2 years after delivery (P < 0.01), whereas subgroup analysis within the vaginal and Cesarean delivery groups did not show significant differences. Although there was no statistical correlation between delivery mode and persisting stress urinary incontinence, women with persisting stress urinary incontinence 2 years after delivery had a larger hiatal area than did women without this clinical symptom (P < 0.01). There were no significant differences in hiatal dimensions in women with bladder urgency or dyspareunia.
3D transperineal ultrasound, which is easily accessible, can provide useful information on morphological changes of the female pelvic floor. Women with a spontaneous or operative vaginal first delivery had a significantly larger hiatal area and axial distension than did women whose first delivery was by Cesarean section, even 2 years after delivery. Performing 3D ultrasound after the first delivery may help to identify women at high risk for persisting pelvic floor disorders.
三维（3D）经会阴超声已被证明是一种可靠且可重复的方法，可用于观察女性会阴提肌的形态变化。本研究旨在评估初产妇分娩后 18-24 个月持续性盆底功能障碍、盆底生物力学测量值与分娩方式之间的关系。
本前瞻性观察性研究招募了 130 名初产妇，她们均在分娩后第二天接受检查。所有产妇均为白种人，且单胎妊娠，头位。使用标准化设置在分娩后第二天（先前已发表结果）和 18-24 个月时进行 3D 经会阴超声检查。在静息和valsalva 动作时获得容积，在轴平面测量会阴裂孔的生物力学测量值。从我们的临床档案中获取产科和体质参数，并在分娩后 18-24 个月时使用标准化问卷评估持续性盆底功能障碍。根据盆底功能障碍的临床症状和分娩方式比较 18-24 个月时的超声测量值，包括阴道分娩（自然分娩与经阴道助产）和剖宫产（初次剖宫产即选择性剖宫产与继发性剖宫产即产程发动后剖宫产）亚组分析。
77 名（59%）女性在分娩后 18-24 个月时完成了完整随访。生物力学测量值显示，阴道分娩组的裂孔面积在分娩后 2 年显著大于剖宫产组（P<0.01），但阴道分娩和剖宫产亚组分析未显示显著差异。尽管分娩方式与持续性压力性尿失禁之间无统计学相关性，但分娩后 2 年仍有压力性尿失禁的女性裂孔面积大于无此临床症状的女性（P<0.01）。膀胱过度活动症或性交困难的女性在裂孔尺寸方面无显著差异。
3D 经会阴超声检查简便易行，可为女性盆底形态变化提供有用信息。阴道分娩或经阴道助产的初产妇裂孔面积和轴向扩张明显大于剖宫产的初产妇，即使在分娩后 2 年也是如此。在首次分娩后进行 3D 超声检查可能有助于识别持续性盆底功能障碍风险较高的女性。
