title: Tridimensional sonographic anatomical changes on pelvic floor muscle according to the type of delivery.
abstract: OBJECTIVE
  The aim of the study was to evaluate the association of avulsion and postnatal hiatal dimensions with delivery mode. These anatomical changes on pelvic floor muscle may be assessed by 3-4D ultrasonography.
  
  
  METHODS
  This is a prospective observational study that included 164 women: 20 nulliparous, 20 primigravid, and 124 postpartum women (62 at 1 month, 62 at 9 months postpartum). We performed an introital 3-4D ultrasonography to assess levator ani muscle's integrity, levator hiatal area at rest, on Valsalva, and on contraction.
  
  
  RESULTS
  Levator ani avulsion was diagnosed in 59.5% of forceps deliveries. There were no statistically significant differences in postnatal hiatal dimensions between normal vaginal deliveries at 9 months postpartum and nulligravid. Levator hiatal area was significantly higher after forceps delivery.
  
  
  CONCLUSIONS
  Low incidence of levator avulsion takes place in normal vaginal deliveries. However, forceps delivery is the riskiest type of delivery for pelvic floor pathology and its recovery.
authors.affiliation: Department of Obstetrics and Gynaecology, Mútua Terrassa University Hospital, Plaça Doctor Robert 5, 08221 Terrassa, Spain. 29215jcg@comb.cat
authors.forename: Jordi
authors.initials: J
authors.lastname: Cassadó Garriga
authors.forename: Antoni
authors.initials: A
authors.lastname: Pessarrodona Isern
authors.forename: Montserrat
authors.initials: M
authors.lastname: Espuña Pons
authors.forename: Montserrat
authors.initials: M
authors.lastname: Durán Retamal
authors.forename: Anna
authors.initials: A
authors.lastname: Felgueroso Fabregas
authors.forename: Monica
authors.initials: M
authors.lastname: Rodriguez-Carballeira
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D005113:Extraction, Obstetrical / Q000009:adverse effects*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging / Q000293:injuries*; D007744:Obstetric Labor Complications / Q000000981:diagnostic imaging / Q000209:etiology; D017773:Pelvic Floor / Q000033:anatomy & histology* / Q000000981:diagnostic imaging / Q000293:injuries / Q000473:pathology*; D011247:Pregnancy; D011446:Prospective Studies; D014463:Ultrasonography; D055815:Young Adult