title: Can we identify changes in fascial paravaginal supports after childbirth?
abstract: BACKGROUND
  Defects of anterior vaginal wall fascia are generally assumed to be factors in the aetiology of cystocele. However, to date, there is very little information on diagnosis by imaging.
  
  
  OBJECTIVE
  To document the appearance of vaginal fornices before and after childbirth using 4D ultrasound volume data sets as an aid in diagnosing paravaginal defects of the anterior vaginal wall.
  
  
  METHODS
  This study was performed by re-analysing data sets obtained in a previously published study involving ante- and postpartum pelvic floor assessment by ultrasound. Two hundred and two nulliparous women had been seen at a mean gestation of 37.2 weeks at two tertiary hospitals. One hundred and sixty-three returned 3 months postpartum. All the participants underwent an interview and 4D translabial ultrasound at both antepartum and postpartum appointments. The integrity of vaginal fornices and levator ani was assessed by tomographic ultrasound.
  
  
  RESULTS
  Vaginal fornices were assessed in both ante- and postnatal volumes, and loss of forniceal tenting was found in 85 patients (52%). On average, seven slices were affected (range, 1-16). On multivariate analysis, controlling for potential confounders, including partial/complete avulsion, loss of forniceal tenting remained independently associated with increased cystocele descent (P = 0.005).
  
  
  CONCLUSIONS
  Vaginal childbirth is associated with loss of tenting of the vaginal fornices, independent of levator trauma, and also with impaired anterior vaginal wall support. This evidence suggests the existence of paravaginal defects and may imply a role for such defects in the causation of anterior vaginal wall prolapse.
authors.affiliation: Department of Obstetrics and Gynaecology, Sydney Medical School Nepean, University of Sydney, Penrith, New South Wales, Australia.
authors.forename: Jordi
authors.initials: J
authors.lastname: Cassadó-Garriga
authors.forename: Vivien
authors.initials: V
authors.lastname: Wong
authors.forename: Kalai
authors.initials: K
authors.lastname: Shek
authors.forename: Hans Peter
authors.initials: HP
authors.lastname: Dietz
mesh_terms: D000293:Adolescent; D000328:Adult; D052858:Cystocele / Q000000981:diagnostic imaging / Q000209:etiology; D005205:Fascia / Q000000981:diagnostic imaging* / Q000293:injuries; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008875:Middle Aged; D036801:Parturition; D017773:Pelvic Floor / Q000000981:diagnostic imaging / Q000293:injuries; D049590:Postpartum Period; D011247:Pregnancy; D011263:Pregnancy Trimester, Third; D014463:Ultrasonography; D014621:Vagina / Q000000981:diagnostic imaging* / Q000293:injuries; D055815:Young Adult
keywords: birth trauma; fascial supports; paravaginal defect; pelvic floor; pelvic organ prolapse