3rd Medical Faculty, Charles University, Prague, Czech Republic.
Institute for the Care of Mother and Child, Prague, Czech Republic.
Acta Obstet Gynecol Scand. 2022 Jun;101(6):628-638. doi: 10.1111/aogs.14344. Epub 2022 Mar 24.
Magnetic resonance imaging (MRI) provides a detailed display of the pelvic floor structures responsible for normal pelvic floor anatomy. The aim of the study is to assess the appearance of musculo-fascial defects in women with pelvic floor dysfunction following first vaginal delivery.
Analysis of axial T3 (Tesla 3) MRI scans from a case control study of symptomatic (n = 149) and asymptomatic (n = 60) women after first vaginal delivery. Presence and severity of pelvic organ support and attachment system defects in three axial pelvic planes were assessed.
In the symptomatic group, major muscular defects were found in 67.1% (for pubovisceral muscle complex) and 87.9% (for iliococcygeal muscle). Only 6.7% of major pubovisceral and 35.0% of major iliococcygeal defects were identified in the controls (p = 0.000). Prolapse patients had an odds ratio (OR) of 22.1 (95% CI 8.94-54.67) to have major pubovisceral muscle complex defect and OR of 4.9 (95% CI 1.51-15.71) to have major iliococcygeal muscle defect. Fascial defects were found in 60.4% and 83.2% the symptomatic group, respectively. Those with prolapse had an OR of 29.1 (95% CI 9.77-86.31) to have facial defect at the level of pubovisceral muscle complex and an OR of 16.9 (95% CI 7.62-37.69) to have fascial defect at the level of iliococcygeal muscle. Uterosacral ligaments detachment was associated with prolapse with an OR of 10.1 (95% CI 4.01-25.29). For the model based on combination on all MRI markers, the area under the receiver operating characteristic curve is 0.921.
This study provides comprehensive data about first vaginal delivery-induced changes in the levator ani muscle and endopelvic fascial attachment system. These changes are seen also in asymptomatic controls, but they are significantly less expressed.
磁共振成像（MRI）提供了负责正常盆底解剖结构的盆底结构的详细显示。本研究的目的是评估首次阴道分娩后盆底功能障碍女性的盆底肌筋膜缺陷的表现。
对一项有症状（n=149）和无症状（n=60）女性首次阴道分娩后病例对照研究的轴向 T3（特斯拉 3）MRI 扫描进行分析。评估三个轴向盆腔平面中盆腔器官支持和附着系统缺陷的存在和严重程度。
在有症状的组中，67.1%（耻骨直肠肌复合体）和 87.9%（髂尾肌）存在主要肌肉缺陷。对照组中仅发现 6.7%的主要耻骨直肠肌和 35.0%的主要髂尾肌缺陷（p=0.000）。脱垂患者发生主要耻骨直肠肌复合体缺陷的优势比（OR）为 22.1（95%CI 8.94-54.67），发生主要髂尾肌缺陷的 OR 为 4.9（95%CI 1.51-15.71）。筋膜缺陷分别在 60.4%和 83.2%的有症状组中发现。有脱垂的患者发生耻骨直肠肌复合体水平筋膜缺陷的 OR 为 29.1（95%CI 9.77-86.31），发生髂尾肌水平筋膜缺陷的 OR 为 16.9（95%CI 7.62-37.69）。子宫骶骨韧带分离与脱垂相关，OR 为 10.1（95%CI 4.01-25.29）。基于所有 MRI 标志物组合的模型，受试者工作特征曲线下面积为 0.921。
本研究提供了关于首次阴道分娩引起的会阴肌和内盆腔筋膜附着系统变化的综合数据。这些变化在无症状的对照组中也有，但表达明显较少。
