Ultrasound examination of the pelvic floor during active labor: A longitudinal cohort study

Introduction There is limited evidence about changes in the pelvic floor during active labor. We aimed to investigate changes in hiatal dimensions during the active first stage of labor and associations with fetal descent and head position. Material and methods We conducted a longitudinal, prospecti...

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Bibliographic Details
Published in:Acta obstetricia et gynecologica Scandinavica 2023-09, Vol.102 (9), p.1203-1209
Main Authors: Eggebø, Torbjørn M., Benediktsdottir, Sigurlaug, Hjartardottir, Hulda, Salvesen, Kjell Å., Volløyhaug, Ingrid
Format: Article
Language:English
Subjects:
Birth
Childbirth & labor
Cohort analysis
Delivery, Obstetric
Female
fetal descent
head position
hiatal dimensions
Humans
Imaging, Three-Dimensional
Infant
injury
labor
levator ani
Longitudinal Studies
obstetrics
Original
pelvic floor
Pelvic Floor - diagnostic imaging
Pelvic Floor - injuries
Pelvis
Pregnancy
prolapse
Prospective Studies
Ultrasonic imaging
Ultrasonography
ultrasound
urogynecology
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Summary:Introduction There is limited evidence about changes in the pelvic floor during active labor. We aimed to investigate changes in hiatal dimensions during the active first stage of labor and associations with fetal descent and head position. Material and methods We conducted a longitudinal, prospective cohort study at the National University Hospital of Iceland, from 2016 to 2018. Nulliparous women with spontaneous onset of labor, a single fetus in cephalic presentation, and gestational age ≥37 weeks were eligible. Fetal position was assessed with transabdominal ultrasound and fetal descent was measured with transperineal ultrasound. Three‐dimensional volumes were acquired from transperineal scanning at the start of the active phase of labor and in late first stage or early second stage. The largest transverse hiatal diameter was measured in the plane of minimal hiatal dimensions. The levator urethral gap was measured as the distance between the center of the urethra and the levator insertion using tomographic ultrasound imaging. Measurements of the levator urethral gap were made in the plane of minimal hiatal dimensions and 2.5 and 5 mm cranial to this. Results The final study population comprised 78 women. The mean transverse hiatal diameter increased 12.4% between the two examinations, from 39.4 ± 4.1 mm (±standard deviation) at the first examination to 44.3 ± 5.8 mm at the last examination (p 
ISSN:0001-6349
1600-0412
DOI:10.1111/aogs.14620