Does levator trauma 'heal'?

Ultrasound Obstet Gynecol. 2012 Nov;40(5):570-5. doi: 10.1002/uog.11203.


Objective: To evaluate if pregnancy- and delivery-related changes to levator morphology and distensibility regress with time.

Methods: 488 nulliparous pregnant women, recruited between 36 and 38 weeks' gestation, were invited for assessment at 3-6 months and again at 2-3 years postpartum. All underwent an interview and four-dimensional translabial ultrasound examination. Hiatal morphometry and bladder neck descent (BND) were determined and compared between the two postpartum visits.

Results: 367 participants returned for assessment at 4.1 (interquartile range (IQR), 3.7-5.0) months and 161 returned at 2.6 (IQR, 2.0-3.1) years, allowing a groupwise comparison. There was no significant difference in hiatal area (22 vs 22 cm(2), P = 0.95) or BND on Valsalva maneuver (26.3 vs 25.5 mm, P = 0.49). Pairwise comparison in women who had attended both postpartum appointments without second births (n = 77), separately for those who had a cesarean section (n = 24) and those who had a vaginal delivery (n = 53) originally, showed no significant changes, except a reduction in BND (31.2 vs 28.3 mm, P = 0.025) in those who had delivered vaginally. Two women out of 12 diagnosed with a levator avulsion at 3-6 months showed obvious anatomical improvement on translabial ultrasound at 2-3 years.

Conclusions: We found no evidence of regression or healing of pregnancy- and delivery-related changes to levator distensibility on comparing imaging data obtained at 3-6 months and 2-3 years postpartum. However, we documented anatomical improvement on translabial ultrasound at the second postpartum visit in two women diagnosed with levator avulsion at 3-6 months postpartum.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cesarean Section
  • Delivery, Obstetric
  • Female
  • Humans
  • Longitudinal Studies
  • Obstetric Labor Complications / diagnostic imaging*
  • Obstetric Labor Complications / physiopathology*
  • Pelvic Floor / diagnostic imaging*
  • Pelvic Floor / physiopathology*
  • Pelvic Organ Prolapse / diagnostic imaging*
  • Pelvic Organ Prolapse / etiology*
  • Pelvic Organ Prolapse / physiopathology*
  • Pregnancy
  • Risk Factors
  • Statistics, Nonparametric
  • Ultrasonography, Prenatal*