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Saturday, July 13, 2013

Trailers (53): Pelvic organ support during pregnancy

Stær-Jensen et al. Ultrasound evaluation of pelvic organ support during pregnancy

Why should you read about this topic?

You’re familiar with the end-result: pelvic organ prolapse and incontinence.  Now we need to know more about how it develops.

What were the authors trying to do?

Investigate whether pregnancy affects levator hiatus dimensions and bladder neck mobility.

Who participated and in what setting?

Nulliparous pregnant women (N=274) at least 18 years old seen at Akershus University Hospital from 2010 to 2011.

What was the study design?

Prospective longitudinal observational (transperineal sonography at 21 and 37 weeks gestational age)

What were the main outcome measures?

Levator hiatus dimensions and displacement of the bladder neck and levator plate

What were the results?

Levator hiatus dimensions were significantly increased at 37 weeks compared with 21 weeks.  Mean area of the levator hiatus was increased 17% at rest and 21% with Valsalva.  Bladder neck mobility increased also.

What is the most interesting image in the paper?


What were the study strengths and weaknesses?

Strengths:  careful estimation of interobserver agreement; excellent retention of study participants.   Weaknesses: observers could not be masked to gestational age; postpartum data are noticeably absent.

What does the study contribute for your practice?

Birth trauma is not the only factor related to pelvic organ support—it’s also pregnancy itself