Association between pelvic floor dysfunction, and clinical and ultrasonographic evaluation in primiparous women: a cross-sectional study
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Disorders related to pelvic floor include urinary incontinence (UI), anal incontinence, pelvic organ prolapse, sexual dysfunction and pelvic pain. Because pelvic floor dysfunctions (PFD) can be diagnosed clinically, imaging techniques serve as auxiliary tools for establishing an accurate diagnosis. The objective is to evaluate the PFD in primiparous women after vaginal delivery and the association between clinical examination and three-dimensional ultrasonography (3DUS).
A cross-sectional study was conducted in a in tertiary maternity. All primiparous women with vaginal deliveries that occurred between January 2013 and December 2015 were invited. Women who attended the invitation underwent detailed anamnesis, questionnaire application, physical examination and endovaginal and endoanal 3DUS. Crude and adjusted predictor factors for PFD were analyzed.
Fifty women were evaluated. Sexual dysfunction was the most prevalent PFD (64.6%). When associated with clinical features and PFD, oxytocin use increased by approximately four times the odds of UI (crude OR 4.182, 95% CI 1.149–15.219). During the multivariate analysis, the odds of UI were increased in forceps use by approximately 11 times (adjusted OR 11.552, 95% CI 11.155–115.577). When the clinical and obstetrical predictors for PFD were associated with 3DUS, forceps increased the odds of lesion of the pubovisceral muscle and anal sphincter diagnosed by 3DUS by sixfold (crude OR 6.000, 95% CI 1.172–30.725), and in multivariate analysis forceps again increased the odds of injury by approximately 7 times (adjusted OR 7.778, 95% CI 1.380–43.846).
Sexual dysfunction was the most frequent PFD. The use of forceps in primiparous women was associated with a greater chance of UI and pelvic floor muscle damage diagnosed by 3DUS.
KeywordsVaginal delivery Pelvic floor dysfunction Ultrasound Childbirth
We would like to acknowledge the members of the Department of Obstetrics and Gynaecology, Medical Informatics and Surgery of the Hospital das Clínicas of Federal University of Minas Gerais for the support to this research. We thank all the primiparous women who participated in the study.
GMV Pereira—protocol/project development, data collection or management, data analysis and manuscript writing/editing. MVC Monteiro—protocol/project development, data collection or management and manuscript writing/editing. ZSN Reis—protocol/project development, data analysis and manuscript writing/editing. BDS Rodrigues, KCLR Buzatti and MC Cruz—data collection or management.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The research project was approved by the Research Ethics Committee of the Federal University of Minas Gerais (UFMG) (CAAE: 42099115.3.0000.5149—26 March 2015).
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