Morphology of female pelvic floor on magnetic resonance imaging in nuliparas compared to primiparas with elective c-section
IUGA Academy. Krcmar M. Jun 30, 2018; 212945; 450
Michal Krcmar
Michal Krcmar

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Morphology of female pelvic floor on magnetic resonance imaging in nuliparas compared to primiparas with elective c-section

Krcmar, M1; Krofta, L1; Feyereisl, J1; Urbankova, I1; Grohregin, K1

1: Institute for the care of mother and child

Introducton: Magnetic resonance imaging can be used in resolution of pelvic floor damage.

Objective: Description of pelvic floor damage caused by pregnancy on MRI scans in the group of primiparas delivering by elective C-section compared to nuliparas.

Methods: This is an unicentric, retrospective and observational study of two groups of women. Group A consists of nuliparas, group B of women delivered by elective Caesarean section. No symptoms of POP were recorded. All the patients were examined according to POP-Q system. In all patients we performed dynamic MRI scan (supine position, 3T, slicing 2-4mm, gap 1mm) in axial, coronal and sagittal projections. In the axial scans, anatomy was evaluated in two parallel planes; (1) at the plane of the inferior pubic ligament that corresponds to the mid-urethra (pL1), and (2) at the plane defined by the bladder base (pL2). Following parameters were measured: urogenital hiatus dimensions (UGH-anteroposterior dimension, width), the distance between the urethra and puborectal muscle insertion (urethral gap, UG), levator ani muscle thickness (pubovisceral muscle complex- PVMC and iliococcygeal muscle- IC), the internal obturator muscle thickness (OIMonly at pL2) and the distance between pL1 and pL2. In axial scans we measured bones biometry including the sacrococcygeal-inferior pubic point distance (SCIPP), the bispinal and bituber diameter (BSD, BTD). Measurements were done at the rest and at the maximal Valsalva manoeuver. We measured the distance between the posterior aspect of the uterine cervix and the sacrococcygeal connection, the levator plate angle (LPA), and the sacrouterine angle (SUA), defined as an angle between the SCIPP line and connection between the sacrococcygeal connection and the posterior aspect of cervix. The difference between left- and right-sided measurements was compared with a paired t-test (SPSS®, ver. 19).

Results: Group A contains 24 patients, group B consists of 18 patients. Both groups statistically differ only in age. All data showed normal distribution, thus they are reported as mean (mm or °). UGH dimensions didn't differ significantly. Group A at pL1: UG 14.0, PVMC thickness 8.1. At pL2: ICM thickness 4.4, OIM thickness 17,6 . The average distance between pL1 and pL2 was 21.6. The bony pelvis dimensions: BSD 109.2, BTD distance 128.2, SCIPP 115.9. Dynamic midsagittal sequences: the sacrococcygeal-uterine cervix distance at the rest 55 and at the Valsalva 49.4; the LPA relaxed 21.5° and at Valsalva 34.7°; the sacrouterine angle relaxed 30.5° and at Valsalva 19.2°. Group B at pL1: UG 15, PVMC thickness 5,5. At pL2: ICM thickness 3,6, OIM thickness 19,5. The average distance between pL1 and pL2 was 18,2. The bony pelvis dimensions: BSD 109.6, BTD 130. SCIPP 89,5. Dynamic midsagittal sequences: the sacrococcygeal-uterine cervix distance at the rest 55 and at the Valsalva 51; the LPA relaxed 18,3 and at Valsalva 25; the sacrouterine angle relaxed 27,8 and at Valsalva 20,1.

Conclusions: Significant differences between those groups were found in age, PMC, IMC and OIM thickness as well as in LP angle within Valsalva. Those data show that some changes in levator ani muscle can develop even within the pregnancy.


Work supported by industry: no.

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