Diastasis of rectus abdominis in the immediate puerperium: correlation between imaging diagnosis and clinical examination

Arch Gynecol Obstet. 2013 Aug;288(2):299-303. doi: 10.1007/s00404-013-2725-z. Epub 2013 Feb 24.


Aim: Diastasis of rectus abdominis is a condition defined as a separation between this muscle and the linea alba, which leads to weakness in the abdominal muscles. Later, such weakness will influence the biomechanical posture causing back pain in women. In the present study, our aim was to assess the accuracy of clinical examination in measuring diastasis of rectus abdominis in the postpartum period.

Method: Puerperal women (n=106) were selected for this study, including caesarean delivery (62 %) and vaginal delivery (38 %). Diastasis of rectus abdominis was measured in the postpartum period using clinical examination and ultrasonography, at four levels of the anterior sheath of the rectus abdominis, in the region above the umbilical scar.

Results: At each level of measurement, the results were statistically analyzed using the Student's t and Pearson tests (confidence interval 95 %), Bland-Altman plot, and Kappa test. The Student t test showed no significant difference between clinical examination and ultrasonography. The Pearson test showed correlation with positive coefficients; moderate correlation (r > 0.5) in the first levels (3, 6, and 9 cm) and a strong correlation (r > 0.75) in the last level (12 cm). In the Kappa test, 65 % of diagnoses given in the clinical examination were confirmed by ultrasonography.

Conclusions: These results show a good agreement between both forms of examination, allowing clinical examination to be used in the diagnosis of rectus muscle diastasis, when ultrasonography is not available.

MeSH terms

  • Adult
  • Confidence Intervals
  • Female
  • Humans
  • Muscular Diseases / diagnosis*
  • Muscular Diseases / diagnostic imaging
  • Physical Examination*
  • Postpartum Period
  • Pregnancy
  • Pregnancy Complications / diagnosis*
  • Pregnancy Complications / diagnostic imaging
  • Rectus Abdominis / diagnostic imaging*
  • Rectus Abdominis / pathology
  • Ultrasonography
  • Young Adult