Department of Reproductive Medicine and Gynecology, University Medical Center, Utrecht, The Netherlands.
MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands.
Ultrasound Obstet Gynecol. 2018 Apr;51(4):537-542. doi: 10.1002/uog.17488.
One of the functional parameters that can be assessed by ultrasound is muscle strain, which represents the extent of deformation of the muscle from its original shape when forces are applied to the tissue under study. The aim of this study was to evaluate the effect of pregnancy and delivery on the puborectalis muscle, by assessing changes in global strain of the muscle during and after pregnancy.
This was a secondary analysis of a prospective observational study on the association between stress urinary incontinence and levator ani muscle avulsion after delivery. Two-hundred and eighty nulliparous pregnant women underwent four-dimensional transperineal ultrasound assessments at 12 and 36 weeks of gestation, and 6 months postpartum. Tomographic ultrasound images were constructed and the puborectalis muscle was delineated by hand using programming software. After delineation, the length of the midline of the puborectalis muscle was measured at rest and during maximum pelvic floor muscle contraction, and global strain was expressed as percentile difference. Postpartum results were analyzed separately for vaginal, operative (vacuum) vaginal and Cesarean delivery. Differences in global strain of the puborectalis muscle according to mode of delivery were compared using a paired-sample t-test. The effect of partial or complete avulsion of the puborectalis muscle on postpartum strain was evaluated by ANOVA.
In total, 254 datasets were analyzed. Global strain of the puborectalis muscle did not change during pregnancy, but after spontaneous or operative vaginal delivery the global strain diminished significantly. No significant change was observed in strain of the puborectalis muscle after Cesarean delivery. Women who suffered complete bilateral avulsion had significantly lower strain compared with women with an intact puborectalis muscle.
Spontaneous or operative vacuum vaginal birth and complete bilateral avulsion of the puborectalis muscle influence negatively the strain of the puborectalis muscle. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
超声可评估的功能参数之一是肌肉应变，它代表了在研究组织上施加力时肌肉从原始形状变形的程度。本研究旨在通过评估怀孕期间和之后肌肉整体应变的变化来评估妊娠和分娩对耻骨直肠肌的影响。
这是一项关于产后压力性尿失禁与肛提肌撕裂之间关联的前瞻性观察性研究的二次分析。280 名初产妇在妊娠 12 周和 36 周以及产后 6 个月时进行了四次经会阴超声评估。构建断层超声图像，并使用编程软件手动描绘耻骨直肠肌。描绘后，在休息和最大盆底肌肉收缩时测量耻骨直肠肌中线的长度，并以百分比差异表示整体应变。分别分析阴道分娩、经阴道（真空）分娩和剖宫产的产后结果。使用配对样本 t 检验比较根据分娩方式的耻骨直肠肌整体应变差异。通过 ANOVA 评估耻骨直肠肌部分或完全撕裂对产后应变的影响。
共分析了 254 组数据集。耻骨直肠肌的整体应变在怀孕期间没有变化，但在自然分娩或经阴道（真空）分娩后，整体应变明显下降。剖宫产术后，耻骨直肠肌的应变没有明显变化。完全双侧撕裂的女性与耻骨直肠肌完整的女性相比，应变明显降低。
自发性或经阴道（真空）分娩以及耻骨直肠肌完全双侧撕裂会对耻骨直肠肌的应变产生负面影响。版权所有©2017 ISUOG。由 John Wiley & Sons Ltd 出版。
