ICS 1999, Denver
Informally discussed posters
Pelvic floor
Early and late effects of spontaneous delivery on the different pelvic floor parameters in primiparae patients without pelvic floor reeducation

S. Meyer, P. Hohlfeld, P. DeGrandi, V. Virtic
Urogenecology Unit, CHUV, Lausanne, Switzerland

Aims of Study: to assess the immediate and long term effects of spontaneous non-instrumentally assisted vaginal delivery on the different pelvic floor parameters in primiparae patients without pelvic floor reeducation.

Methods: 47 primimparae women were investigated on three occasions: during pregnancy (T1), 8 weeks (T2) and 10 months (T3) after vaginal delivery. None of them received any form of pelvic floor reeducation. Following parameters were considered: history of stress incontinence/ decreased sexual vaginal response/ fecal incontinence; bladder neck (BN) position and mobility determined with perineosonography, utrethral stress pressure profile parameters in the standing position, intra-vaginal and intra-anal pressures during anus squeezing. These parameters measured at T2 and T3 were compared to the predelivery values measured at T1.

Results: 18 Women (38%) experienced stress urinary incontinence (SUI) during pregnancy: among these patients, only 5 women (10.5% of the whole population) had persistent SUI at T3 examination. The sexual vaginal response was delayed and/or decreased in its intensity in 25% at T3, whereas fecal incontinence was present in 2 patients (4% of the whole population) at T3.

BN position in the standing position remained unchanged (T1: 26±5mm, T2: 25±5mm, T3: 27±4mm, P: 0.7/0.5) whereas BN mobility was significantly increased (T1: 11±4mm, T2: 14±6mm, T3: 15±5mm, P: 0.05/0.001) after delivery. Urethral pressure profiles at stress in the standing position were as follows:

-functional length was significantly decreased two months after delivery, but regained predelivery values ten months after delivery (T1: 32±8mm, T2: 27±7mm, T3: 31±7mm, P: 0.004/0.5).

-area of continence at rest was not significantly modified by delivery (T1: 142±643mm2, T2: 1244±485 mm2, T3: 1511±584, P: 0.4/0.6) as well as maximal urethral closure pressure (T1: 80±35cmH2O, T2: 80±31cmH2O, T3: 85±31cmH2O, P: 0.9/0.5).

-pressure transmission ratio measured in the medium third of urethral functional length showed a significant decrease two months after delivery, but returned to normal values ten months after delivery (T1: 72±21%, T2: 61±25%, T3: 74±24%, P: 0.05/0.4) whereas residual area of continence at stress was not significantly modified by delivery (T1: 605±454mm2, T2: 559±338mm2, T3: 549±342 mm2, P: 0.9/0.7).

Intra-vaginal pressures showed no significant modifications (T1: 35±20cmH2O, T2: 31±23 cmH2O, T3: 42±29 cmH2O, P: 0.4/0.1) after delivery, whereas intra-anal pressures show a significant decrease two months after delivery, but returned to normal ten months after delivery. (T1: 44±22cmH2O, T2: 33±20cmH2O, T3: 44±24cmH2O, P: 0.02/0.8).

Conclusions: ten months after a spontaneous vaginal delivery, in the absence of pelvic floor reeducation, 10% of patients had SUI, 25% described a slight decrease in the vaginal sexual response and 4% a fecal incontinence. Compared to predelivery values measured during pregnancy, the urethral pressure profiles parameters measured at stress in the standing position showed no significant modifications, apart from a transient decrease of urethral functional length. Similary intra-vaginal pressures as well as intra-anal pressures during pelvic floor contraction showed no significant decrease when measured ten months after delivery.