Current approaches to diagnosing damages to the pelvic floor structures during childbirth
The authors analyzed current approaches to diagnosing pelvic floor damages during childbirth. Analysis of the data available in the literature showed that damage to the puborectalis muscle is the most common consequence of vaginal delivery. Current diagnostic principles, such as perineal 2D/3D ultrasound, significantly extend the possibilities of examination in female patients with pelvic floor damages, allowing for objectifying the process of examination and treatment. aking into account the efficiency of the given approaches to diagnosing birth trauma, they should be introduced into practical health care.Apolikhina I.A., Chochueva A.S., Gus A.I., Ignatyeva A.A., Bychkona A.E.
Keywords
References
1. Cyr M.P., Kruger J., Wong V., Dumoulin C., Girard I., Morin M. Pelvic floor morphometry and function in women with and without puborectalis avulsion in the early postpartum period. Am. J. Obstet. Gynecol. 2017; 216(3): 274. e1-274. e8.
2. Lanzarone V., Dietz H.P. Three-dimensional ultrasound imaging of the levator hiatus in late pregnancy and associations with delivery outcomes. Aust. N. Z. J. Obstet. Gynaecol. 2007; 47(3): 176-80.
3. Toozs-Hobson P., Balmforth J., Cardozo L., Khullar V., Athanasiou S. The effect of mode of delivery on pelvic floor functional anatomy. Int. Urogynecol. J. Pelvic Floor Dysfunct. 2008; 19(3): 407-16.
4. Shek K.L., Dietz H.P. Can levator avulsion be predicted antenatally? Am. J. Obstet. Gynecol. 2010; 202(6): 586. e1-6.
5. Dietz H.P., Shek C., Clarke B. Biometry of the pubovisceral muscle and levator hiatus by three-dimensional pelvic floor ultrasound. Ultrasound Obstet. Gynecol. 2005; 25(6): 580-5.
6. Yang J.M., Yang S.H., Huang W.C. Biometry of the pubovisceral muscle and levator hiatus in nulliparous Chinese women. Ultrasound Obstet. Gynecol. 2006; 28(5): 710-6.
7. Dietz H. Pelvic floor trauma in childbirth. Aust. N. Z. J. Obstet. Gynaecol. 2013; 53(3): 220-30.
8. Dietz H. Prolapse worsens with age, doesn’t it? Aust. N. Z. J. Obstet. Gynaecol. 2008; 48(6): 587-91.
9. Dixit P., Shek K., Dietz H. How common is pelvic floor muscle atrophy after vaginal childbirth? Ultrasound Obstet. Gynecol. 2014; 43: 83-8.
10. Dietz H.P. Pelvic organ prolapse - a review. Aust. Fam. Physician. 2015; 44(7): 446-52.
11. Токтар Л.Р., Крыжановская А.Н. Ранняя диагностика интранатальных травм промежности как первый шаг к решению проблемы. Status Praesens. 2012; 5: 61-7. [Toktar L.R., Kryzhanovskaya A.N. Early diagnosis of intrauterine crotch injuries as the first step to solving the problem. Status Praesens. 2012; 5: 61-7. (in Russian)]
12. Van Brummen H.J., Bruinse H.W., van de Pol G., Heintz A.P., van der Vaart C.H. Bothersome lower urinary tract symptoms 1 year after first delivery: prevalence and the effect of childbirth. BJU Int. 2006; 98(1): 89-95.
13. Sangsawang B., Sangsawang N. Stress urinary incontinence in pregnant women: a review of prevalence, pathophysiology, and treatment. Int. Urogynecol. J. 2013; 24(6): 901-12.
14. Wijma J., Weis Potters A.E., de Wolf B.T., Tinga D.J., Aarnoudse J.G. Anatomical and functional changes in the lower urinary tract during pregnancy. BJOG. 2001; 108(7): 726-32.
15. Shek K.L., Dietz H.P. The effect of childbirth on hiatal dimensions. Obstet. Gynecol. 2009; 113(6): 1272-8.
16. Lien K.C., Mooney B., DeLancey J.O., Ashton-Miller J.A. Levator ani muscle stretch induced by simulated vaginal birth. Obstet. Gynecol. 2004; 103(1): 31-40.
17. DeLancey J.O., Kearney R., Chou Q., Speights S., Binno S. The appearance of levator ani muscle abnormalities in magnetic resonance images after vaginal delivery. Obstet. Gynecol. 2003; 101(1): 46-53.
18. Dietz H.P., Lanzarone V. Levator trauma after vaginal delivery. Obstet. Gynecol. 2005; 106(4): 707-12.
19. DeLancey J.O. Anatomy and biomechanics of genital prolapse. Clin. Obstet. Gynecol. 1993; 36(4): 897-909.
20. Ashton-Miller J.A., DeLancey J.O. Functional anatomy of the female pelvic floor. Ann. N. Y. Acad. Sci. 2007; 1101: 266-96.
21. Dietz H.P., Kamisan Atan I., Salita A. The association between ICS POPQ coordinates and translabial ultrasound findings. Ultrasound Obstet. Gynecol. 2016; 47(3): 363-8.
22. Bø K., Berghmans B., Mørkved S., Van Kampen M., eds. Evidence-based physical therapy for the pelvic floor. Bridging science and clinical practice. Elsevier Ltd.; 2007. 435p.
23. Kearney R., Miller J.M., Ashton-Miller J.A., Delancey J.O. Obstetric factors associated with levator ani muscle injury after vaginal birth. Obstet. Gynecol. 2006; 107(1): 144-9.
24. Otcenasek M., Krofta L., Baca V., Grill R., Kucera E., Herman H. et al. Bilateral avulsion of the puborectal muscle: magnetic resonance imaging-based three dimensional reconstruction and comparison with a model of a healthy nulliparous woman. Ultrasound Obstet. Gynecol. 2007; 29(6): 692-6.
25. Dietz H.P., Gillespie A., Phadke P. Avulsion of the pubovisceral muscle associated with large vaginal tear after normal vaginal delivery at term. Aust. N. Z. J. Obstet. Gynaecol. 2007; 47(4): 341-4.
26. Huang W.C., Yang J.M. Bladder neck funneling on ultrasound cystourethrography in primary stress urinary incontinence: a sign associated with urethral hypermobility and intrinsic sphincter deficiency. Urology. 2003; 61(5): 936-41.
27. Haylen B.T., de Ridder D., Freeman R.M., Swift S.E., Berghmans B., Lee J. et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int. Urogynecol. J. 2010; 21(1): 5-26.
28. Hirai K., Sumi T., Kanaoka Y., Ishiko O. Female urinary incontinence: diagnosis, treatment and patients’ concerns. Drugs Today (Barc.). 2002; 38(7):487-93.
29. Blain G., Dietz H.P. Symptoms of female pelvic organ prolapsed: correlation with organ descent in women with single compartment prolapsed. Aust. N. Z. J. Obstet. Gynaecol. 2008; 48(3): 317-21.
30. Dietz H.P., Clarke B., Herbison P. Bladder neck mobility and urethral closure pressure as predictors of genuine stress incontinence. Int. Urogynecol. J. 2002; 13(5): 289-93.
31. Dietz H.P., Nazemian K., Shek K.L., Martin A. Can urodynamic stress incontinence be diagnosed by ultrasound? Int. Urogynecol. J. 2013; 24(8): 1399-403.
32. Dietz H.P. Ultrasound imaging of the pelvic floor. Part I: two-dimensional aspects. Ultrasound Obstet. Gynecol. 2004; 23(1): 80-92.
33. Schaer G.N., Perucchini D., Munz E., Peschers U., Koechli O.R., Delancey J.O. Sonographic evaluation of the bladder neck in continent and stress-incontinent women. Obstet. Gynecol. 1999; 93(3): 412-6.
34. Wijma J., Tinga D., Visser G. Perineal ultrasonography in women with stress urinary incontinence and controls: the role of pelvic floor muscles. Obstet. Gynecol. Invest. 1991; 32(3): 176-9.
35. Dietz H.P., Jarvis S.K., Vancaillie T.G. The assessment of levator muscle strength: a validation of three ultrasound techniques. Int. Urogynecol. J. Pelvic Floor Dysfunct. 2002; 13(3): 156-9.
36. van Veelen G.A., Schweitzer K.J., van der Vaart C.H. Ultrasound imaging of the pelvic floor: changes in anatomy during and after first pregnancy. Ultrasound Obstet. Gynecol. 2014; 44(4): 476-80.
37. Caudwell-Hall J., Kamisan Atan I., Martin A., Guzman Rojas R., Langer S., Shek K., Dietz H.P. Intrapartum predictors of maternal levator ani injury. Acta Obstet. Gynecol. Scand. 2017; 96(4): 426-31.
38. Васильченко О.Н. Повреждения промежности и сфинктера прямой кишки в родах (клиника, диагностика, лечение и профилактика): дисс. … канд. мед. наук. М.; 2003. [Vasilchenko O.N. Damage to the perineum and sphincter of the rectum during childbirth (clinic, diagnosis, treatment and prevention): diss. ... cand. med. sciences. Moscow; 2003. (in Russian)]
Received 08.12.2017
Accepted 22.12.2017
About the Authors
Inna A. Apolikhina, MD, Head of the Department of Aesthetic Gynecology and Rehabilitation, National Medical Research center of Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov, Ministry of Health of Russia. 117997, Russia, Moscow, Ac. Oparina str. 4. E-mail: i_apolikhina@oparina4.ruAdalina S. Chochueva, resident of the National Medical Research center of Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov,
Ministry of Health of Russia. 117997, Russia, Moscow, Ac. Oparina str. 4. E-mail: adalina_chochueva@mail.ru
Alexander I. Gus, MD, Head of the Department of Ultrasound and Functional Diagnostics, National Medical Research center of Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov, Ministry of Health of Russia. 117997, Russia, Moscow, Ac. Oparina str. 4. E-mail: a_gus@oparina4.ru
Alla A. Ignatyeva, Ph.D., head of the 2nd obstetric physiological department, National Medical Research center of Obstetrics, Gynecology and Perinatology named
after Academician V.I. Kulakov, Ministry of Health of Russia. 117997, Russia, Moscow, Ac. Oparina str. 4. E-mail: a_ignateva@oparina4.ru
Anastasia E. Bychkova, doctor of the department of aesthetic gynecology and rehabilitation, National Medical Research center of Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov, Ministry of Health of Russia. 117997, Russia, Moscow, Ac. Oparina str. 4. E-mail: a_bychkova@oparina4.ru
For citations: Apolikhina I.A., Chochueva A.S., Gus A.I., Ignatyeva A.A., Bychkona A.E. Current approaches to diagnosing damages to the pelvic floor structures during childbirth. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2018; (7): 20-5. (in Russian)
https://dx.doi.org/10.18565/aig.2018.7.20-25