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Evaluation of Levator ani muscle injury in primiparous women at one and six week’s postpartum using 3D transperineal ultrasound: comparative Cohort study

: Introduction: Vaginal birth is known to be the main etiological factor for development of levator ani defects. Transperineal ultrasonography has been used extensively for pelvic floor assessment with minimal discomfort to the patient and lower cost. The aim : is to define and evaluate changes in the levator ani muscle in the first week and at 6 weeks after delivery with 3D Transperineal ultrasonography. Methods: retrospective study of 355 eligible primiparous women who delivered vaginally, and had been examined within the first week and 6 weeks after delivery with 3D transperineal ultrasonography. Results: women showed a significantly larger hiatal area at rest and on Valsalva, 6weeks post partum, LAM avulsions decreased at 6weeks to be 13.2%. Conclusions: first vaginal delivery led to persistent hiatal area enlargement. Levator ani muscle avulsions can be diagnosed easily by 3D ultrasound, and they are not the only cause of stress urinary incontinence after vaginal delivery. The study included all primipara who delivered singleton full-term fetus with cephalic presentation and they were recruited during their first post-partum visit and one week post-delivery. The study did not include any woman who had multifetal pregnancy or congenital anomalies of the genital tract. All data about maternal medical, surgical and obstetrical history, maternal age, and maternal body mass index, duration of second stage of labor, episiotomy, maternal injuries, neonatal birth weight, and neonatal head circumference were obtained from the files. Also records of vaginal examination and pelvic organ prolapse quantification were obtained and analyzed. The modified questionnaire on symptoms of pelvic floor dysfunction was filled by the patients in both visits. Offline analysis of the stored volumes of the two 3D ultrasound examinations was done. The first examination was performed 7days after delivery and the second examination was done 6weeks post-delivery by experienced sonographers using a GE Voluson p8 (GE Healthcare) equipped with a 4–8 ‐ MHz curved array 3D ultrasound transducer. The field of view angle was set to a maximum of 70° in the sagittal plane and the volume acquisition angle to 85° in the axial plane. Two 3D volumes (one with the patient at rest and one during valsalva maneuver), were recorded. Ultrasound images were obtained after empting the bladder, while the patient in the supine position. Measurements were performed in the axial plane at the level of ‘minimal hiatal dimensions’. The following sonographic parameters were measured and recorded: