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Structural changes in puborectalis muscle after vaginal delivery.

M K Van de Waarsenburg1, C H van der Vaart1, M I J Withagen1

  • 1Department of Obstetrics and Gynecology, University Medical Centre Utrecht, Utrecht, The Netherlands.

Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology
|June 28, 2018
PubMed
Summary

Puborectalis muscle echogenicity significantly decreases after vaginal delivery due to trauma, but recovers over 24 weeks. Muscle area remains constant, suggesting healing involves tissue changes rather than structural regrowth.

Keywords:
3D/4Dareaechogenicitypostpartumrecoverytransperineal ultrasound

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Area of Science:

  • Obstetrics and Gynecology
  • Pelvic Floor Imaging
  • Musculoskeletal Ultrasound

Background:

  • Vaginal delivery can impact pelvic floor structures.
  • The puborectalis muscle plays a crucial role in pelvic floor support.
  • Understanding muscle recovery post-delivery is vital for postpartum care.

Purpose of the Study:

  • To evaluate changes in puborectalis muscle structural composition after vaginal delivery.
  • To assess the recovery of the puborectalis muscle using ultrasound.
  • To correlate echogenicity and area measurements with postpartum time.

Main Methods:

  • 3D/4D transperineal ultrasound used in 20 nulliparous women.
  • Measurements of mean echogenicity (MEP) and area (PMA) of the puborectalis muscle.
  • Longitudinal assessment from 12 weeks gestation up to 24 weeks postpartum.

Main Results:

  • Mean echogenicity (MEP) significantly decreased post-delivery compared to pregnancy.
  • MEP showed significant recovery from 1 day to 24 weeks postpartum.
  • Puborectalis muscle area (PMA) remained constant at rest and during Valsalva maneuver.

Conclusions:

  • Post-vaginal delivery puborectalis muscle echogenicity decrease likely due to trauma, edema, and hematoma.
  • Increasing echogenicity over time suggests resolution of edema/hematoma and scar tissue formation.
  • Muscle area stability indicates recovery may involve tissue remodeling rather than regeneration.