title: Influence of spontaneous and instrumental vaginal delivery on objective measures of pelvic organ support: assessment with the pelvic organ prolapse quantification (POPQ) technique and functional cine magnetic resonance imaging.
abstract: OBJECTIVE
  To determine the influence of spontaneous and instrumented vaginal delivery on objective measures of pelvic organ support.
  
  
  METHODS
  Prospective study at a university hospital with two study groups: vaginal spontaneous delivery (n = 26) and vacuum extraction (n = 49). Control group consisted of healthy nulliparous volunteers (n = 20). Participants underwent pelvic organ support evaluation by use of the pelvic organ prolapse quantification (POPQ) examination and postpartum functional cine magnetic resonance imaging (MRI).
  
  
  RESULTS
  Significant differences for individual POPQ component measurements were noted for points Aa and Ba, TVL, and GH (spontaneous delivery versus control) and in addition for Ap, Bp, and D (vacuum extraction versus control). Significant differences for MRI measurements were observed for the position of bladder base, bladder neck, posterior fornix of the vagina, anorectal junction, hiatus perimeter and depth of rectocele.
  
  
  CONCLUSIONS
  Considerable changes in pelvic organ support after vaginal delivery can be demonstrated by a reproducible and reliable clinical classification system (POPQ) and by functional cine magnetic resonance imaging.
authors.affiliation: Department of Obstetrics and Gynecology, University of Munich, Grosshadern, Marchioninistr. 15, D-81377 Munich, Germany. christian.dannecker@med.uni-muenchen.de
authors.forename: Christian
authors.initials: C
authors.lastname: Dannecker
authors.forename: Andreas
authors.initials: A
authors.lastname: Lienemann
authors.forename: Tanja
authors.initials: T
authors.lastname: Fischer
authors.forename: Christoph
authors.initials: C
authors.lastname: Anthuber
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000473:pathology; D036861:Delivery, Obstetric / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D010298:Parity; D011247:Pregnancy; D012007:Rectum / Q000473:pathology; D015203:Reproducibility of Results; D001743:Urinary Bladder / Q000473:pathology; D014596:Uterine Prolapse / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D014620:Vacuum Extraction, Obstetrical / Q000009:adverse effects*