How well can pelvic floor muscles with major defects contract? A cross‐sectional comparative study 6 weeks after delivery using transperineal 3 D/4 D ultrasound and manometer
Abstract
Objective: To investigate ability to contract, vaginal resting pressure (VRP), pelvic floor muscle (PFM) strength and PFM endurance 6 weeks after vaginal delivery in primiparous women, with and without major defects of the levator ani (LA) muscle. Design: Cross‐sectional comparative study. Setting: Akershus University Hospital, N orway. Sample: A cohort of 175 singleton primiparous women delivering vaginally after more than 32 weeks of gestation. Methods: Major LA defects were assessed by 3 D/4 D transperineal ultrasound at maximal PFM contraction, using tomographic imaging. VRP, PFM strength and PFM endurance were measured vaginally by manometer. Data were analysed by independent‐samples Student's t test, chi‐square test, and standard multiple and simple linear regression. Main outcome measures: VRP, PFM strength and PFM endurance. Results: Of the women included in the study, 4% were not able to contract their PFM 6 weeks after delivery. Women with major LA defects (n = 55) had 47% lower PFM strength and 47% lower endurance when compared with women without major LA defects (n = 120). Mean differences were 7.5 cm H2O (95% CI 5.1–9.9, P < 0.001) and 51.2 cm H2O seconds (95% CI 32.8–69.6, P < 0.001), respectively. These estimates were unchanged by adjustment in multivariable linear regression for potentially confounding demographic and obstetric factors. No difference was found regarding VRP (P = 0.670). Conclusions: Women with major LA defects after vaginal delivery had pronounced lower PFM strength and endurance than women without such defects; however, most women with major LA defects were able to contract the PFM. This indicates a potential capacity by non‐injured muscle fibres to compensate for loss in muscle strength, even at an early stage after delivery.
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Major tears of the pelvic floor muscle after vaginal birth result in a 50% reduction in muscle strength.
“major tears of the PFM after vaginal birth result in a 50% reduction in muscle strength [18].”
From International urogynecology consultation chapter 3 committee 2; conservative treatment of patient with pelvic organ prolapse: Pelvic floor muscle training (2022) · cites this paper as [18]
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“An increased levator hiatus area, measured by ultrasound, is associated with a low vaginal resting pressure, measured with manometry [17], and major tears of the PFM after vaginal birth result in a 50% reduction in muscle strength [18].”
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- Authors
- Hilde, G., Stær‐Jensen, J., Siafarikas, F., Gjestland, K., Ellström Engh, M., & Bø, K.
- Affiliations
- Akershus University Hospital (NO)
- Department of Obstetrics and Gynaecology Akershus University Hospital Lørenskog Norway
- University of Oslo (NO)
- Corresponding author
- Hilde, G
- Venue
- BJOG: An International Journal of Obstetrics & Gynaecology
- Publisher
- Wiley
- Published
- 2013-07-03
- Volume
- 120
- Issue
- 11
- Pages
- 1423-1429
- ISSN
- 0306-5456 (ISSN-L)
- 1470-0328
- 1471-0528
- OpenAlex
- W2042744184
- Cited by
- 32
- References
- 32
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 3 · 2023: 3 · 2022: 4 · 2021: 1 · 2020: 2 · 2019: 1 · 2018: 4 · 2016: 3 · 2015: 4 · 2014: 3
- FWCI
- 2.73
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- BJOG An International Journal of Obstetrics & Gynaecology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Norges Forskningsråd
- Topics
- Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
- Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pregnancy-related medical research
- Keywords
- pelvic floor muscle strength, pelvic floor muscle endurance, vaginal delivery, primiparous women, muscle compensation
- MeSH terms
- Adult, Cross-Sectional Studies, Female, Humans, Manometry, Muscle Contraction, Ultrasonography, Linear Models, Pelvic Floor, Imaging, Three-Dimensional, Parturition, Postpartum Period, Muscle Strength
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