Defining “normal recovery” of pelvic floor function and appearance in a high-risk vaginal delivery cohort

Abstract

Introduction and Hypothesis:

Childbirth pelvic floor trauma leads to pelvic floor disorders. Identification of significant injuries would facilitate intervention for recovery. Our objectives were to identify differences in pelvic floor appearance and function following delivery and identify patterns of normal recovery in women sustaining high-risk labor events.

Methods:

We completed a prospective cohort study comparing women having vaginal births with risk factors for pelvic floor injury to women having cesareans. Data were collected on multidimensional factors including levator ani muscle (LA) tears. Descriptive and bivariate statistics were used to compare the groups. We identified potential markers of pelvic floor injury based on effect size.

Results:

Eighty-two women post vaginal delivery and 30 women post cesarean enrolled. The vaginal group had decreased perineal body length between early postpartum, six weeks (p<0.001), and six months (p=0.001). POP-Q points did not change between any time point (all p>0.05). Measures of strength improved between each time point (all p<0.002). When compared to cesarean, women post vaginal birth had longer genital hiatus and lower anterior and posterior vaginal walls (all p<0.05).

Based on theoretical considerations and effect sizes, those with Bp ≥0 cm, Kegel force ≤1.50 N, and/or an LA tear on imaging were considered to have significant pelvic floor injury. Using this definition, at six weeks, 27 (46.4%) women were classified as injured. At six months, 13 (29.6%) remained injured.

Conclusions:

We propose pelvic floor muscle strength, posterior vaginal wall support, and imaging consistent with LA tear as potential indicators of abnormal or prolonged recovery in this cohort with high-risk labor events.

Brief Summary:

Diminished strength, posterior vaginal wall descent, and levator injury are potential markers of non-recovery from childbirth in women at high risk for pelvic floor damage.