Bertrand Gachon1,2, Xavier Fritel3,4,5, Laetitia Fradet6, Arnaud Decatoire6, Patrick Lacouture6, Henri Panjo4, Fabrice Pierre3, David Desseauve3,6. 1. Department of Obstetrics and Gynecology, La Miletrie University Hospital, 2 rue de la Milétrie CS90577, 86021, Poitiers Cedex, France. bertrand.gachon@gmail.com. 2. P' Institute - RoBioSS Unit, Poitiers University - ENSMA, CNRS UPR 3346, Futuroscope, France. bertrand.gachon@gmail.com. 3. Department of Obstetrics and Gynecology, La Miletrie University Hospital, 2 rue de la Milétrie CS90577, 86021, Poitiers Cedex, France. 4. INSERM, Center for Research in Epidemiology and Population Health (CESP), U1018, Gender, Sexuality and Health Team, Paris-Sud University, UMRS 1018, Villejuif, France. 5. INSERM CIC-P 1402, La Miletrie University Hospital, Poitiers, France. 6. P' Institute - RoBioSS Unit, Poitiers University - ENSMA, CNRS UPR 3346, Futuroscope, France.
Abstract
INTRODUCTION AND HYPOTHESIS: The impact of pregnancy on pelvic floor disorders remains poorly understood. During pregnancy, an increase in ligamentous laxity and pelvic organ mobility is often reported. Our main objective was to investigate a possible association between peripheral ligamentous laxity and levator hiatus (LH) distension during pregnancy. METHODS: This was a prospective longitudinal study of 26 pregnant women followed up from the first to the third trimester. We collected the following information: occurrence of pelvic organ prolapse (POP) symptoms (score higher than 0 for the POP section of the Pelvic Floor Distress Inventory 20 questions score), 4D perineal ultrasound scan results with LH distension assessment and measurement of metacarpophalangeal joint mobility (MCP laxity). The association between MCP laxity and LH distension was estimated by mixed multilevel linear regression. The associations between MCP laxity and categorical parameters were estimated in a multivariate analysis using a generalized estimating equation model. RESULTS: MCP laxity and LH distension were correlated with a correlation coefficient of 0.26 (p = 0.02), and 6.8% of the LH distension variance was explained by MCP laxity. In the multivariate analysis, MCP laxity was associated with POP symptoms with an odds ratio at 1.05 (95% CI 1.01-1.11) for an increase of 1° in MCP laxity. CONCLUSION: LH distension and peripheral ligamentous laxity are significantly associated during pregnancy. However, the relationship is weak, and the results need to be confirmed in larger populations and with more specific techniques such as elastography to directly assess the elastic properties of the pelvic floor muscles.
INTRODUCTION AND HYPOTHESIS: The impact of pregnancy on pelvic floor disorders remains poorly understood. During pregnancy, an increase in ligamentous laxity and pelvic organ mobility is often reported. Our main objective was to investigate a possible association between peripheral ligamentous laxity and levator hiatus (LH) distension during pregnancy. METHODS: This was a prospective longitudinal study of 26 pregnant women followed up from the first to the third trimester. We collected the following information: occurrence of pelvic organ prolapse (POP) symptoms (score higher than 0 for the POP section of the Pelvic Floor Distress Inventory 20 questions score), 4D perineal ultrasound scan results with LH distension assessment and measurement of metacarpophalangeal joint mobility (MCP laxity). The association between MCP laxity and LH distension was estimated by mixed multilevel linear regression. The associations between MCP laxity and categorical parameters were estimated in a multivariate analysis using a generalized estimating equation model. RESULTS:MCP laxity and LH distension were correlated with a correlation coefficient of 0.26 (p = 0.02), and 6.8% of the LH distension variance was explained by MCP laxity. In the multivariate analysis, MCP laxity was associated with POP symptoms with an odds ratio at 1.05 (95% CI 1.01-1.11) for an increase of 1° in MCP laxity. CONCLUSION: LH distension and peripheral ligamentous laxity are significantly associated during pregnancy. However, the relationship is weak, and the results need to be confirmed in larger populations and with more specific techniques such as elastography to directly assess the elastic properties of the pelvic floor muscles.
Authors: R C Bump; A Mattiasson; K Bø; L P Brubaker; J O DeLancey; P Klarskov; B L Shull; A R Smith Journal: Am J Obstet Gynecol Date: 1996-07 Impact factor: 8.661
Authors: Jennifer M Wu; Catherine A Matthews; Mitchell M Conover; Virginia Pate; Michele Jonsson Funk Journal: Obstet Gynecol Date: 2014-06 Impact factor: 7.661
Authors: Wenjin Cheng; Emily English; Whitney Horner; Carolyn W Swenson; Luyun Chen; Fernanda Pipitone; James A Ashton-Miller; John O L DeLancey Journal: Int Urogynecol J Date: 2022-09-21 Impact factor: 1.932