Post-partum pelvic floor dysfunction assessed on 3D rotational ultrasound: a prospective study on women with first- and second-degree perineal tears and episiotomy

• Published in: The journal of maternal-fetal & neonatal medicine 2021-02, Vol.34 (3), p.445-455
• Main Authors: Leombroni, Martina, Buca, Danilo, Liberati, Marco, Falò, Eleonora, Rizzo, Giuseppe, Khalil, Asma, Manzoli, Lamberto, Flacco, Maria Elena, Santarelli, Alessandro, Makatsariya, Alexander, Frondaroli, Franco, D'Antonio, Francesco
• Format: Article
• Language: English
• Subjects: 3D pelvic floor ultrasound; episiotomy; Kristeller maneuver; levator ani muscle; perineal tears; post-partum pelvic floor dysfunction
• ISSN: 1476-7058; 1476-4954
• DOI: 10.1080/14767058.2019.1609932

Purpose: To evaluate the morphology and biometry of pelvic floor structures 3 months after birth in women experiencing first- or second-degree perineal tears or undergoing episiotomy during labor. Material and methods: Prospective observational study including nulliparous women delivering at term with a clinical diagnosis of first- or second-degree perineal tears after birth or undergoing episiotomy. The role of Kristeller maneuver during labor in affecting pelvic structure and function is also explored. All women underwent 2D trans-perineal and 3D endovaginal or endoanal ultrasound 3 months after birth. Results: 115 women assessed 3 months after delivery were enrolled in the study. Compared with controls, women who experienced first-degree perineal tears had higher bladder neck-symphysis (versus 20.9 ± 4.9 versus 16.1 ± 4.9 mm, p = .017), bladder wall-pubic symphysis (22.4 ± 7.4 versus 14.2 ± 9.5 mm, p = .02) and anorectal angle-symphysis distance (12.5 ± 4.7 versus 9.3 ± 4.3 mm, p = .018). Furthermore, they have thicker internal and external anal sphincter. The incidence of partial right and left pubo-rectalis muscle avulsion was higher in women experiencing first-degree vaginal tear during labor (16.2 versus 0%, p = .004 for both). In women affected by second-degree tears, the occurrence of partial avulsion of the right and left pubo-rectalis muscle was 16.2%, while Oasis was detected in 10.8% of the cases. Women receiving Kristeller maneuver during labor had a higher incidence of either right or left puborectalis muscle avulsion. Conclusion: Women who had either first- and second-degree perineal tears or episiotomy show signs of abnormal pelvic morphometry on 3D rotational ultrasound 3 months after birth.