title: Is levator hiatus distension associated with peripheral ligamentous laxity during pregnancy?
abstract: OBJECTIVE
  The impact of pregnancy on pelvic floor disorders remains poorly understood. During pregnancy, an increase in ligamentous laxity and pelvic organ mobility is often reported. Our main objective was to investigate a possible association between peripheral ligamentous laxity and levator hiatus (LH) distension during pregnancy.
  
  
  METHODS
  This was a prospective longitudinal study of 26 pregnant women followed up from the first to the third trimester. We collected the following information: occurrence of pelvic organ prolapse (POP) symptoms (score higher than 0 for the POP section of the Pelvic Floor Distress Inventory 20 questions score), 4D perineal ultrasound scan results with LH distension assessment and measurement of metacarpophalangeal joint mobility (MCP laxity). The association between MCP laxity and LH distension was estimated by mixed multilevel linear regression. The associations between MCP laxity and categorical parameters were estimated in a multivariate analysis using a generalized estimating equation model.
  
  
  RESULTS
  MCP laxity and LH distension were correlated with a correlation coefficient of 0.26 (p = 0.02), and 6.8% of the LH distension variance was explained by MCP laxity. In the multivariate analysis, MCP laxity was associated with POP symptoms with an odds ratio at 1.05 (95% CI 1.01-1.11) for an increase of 1° in MCP laxity.
  
  
  CONCLUSIONS
  LH distension and peripheral ligamentous laxity are significantly associated during pregnancy. However, the relationship is weak, and the results need to be confirmed in larger populations and with more specific techniques such as elastography to directly assess the elastic properties of the pelvic floor muscles.
authors.affiliation: Department of Obstetrics and Gynecology, La Miletrie University Hospital, 2 rue de la Milétrie CS90577, 86021, Poitiers Cedex, France. bertrand.gachon@gmail.com.|P' Institute - RoBioSS Unit, Poitiers University - ENSMA, CNRS UPR 3346, Futuroscope, France. bertrand.gachon@gmail.com.
authors.forename: Bertrand
authors.identifier: http://orcid.org/0000-0002-5772-6828
authors.initials: B
authors.lastname: Gachon
authors.affiliation: Department of Obstetrics and Gynecology, La Miletrie University Hospital, 2 rue de la Milétrie CS90577, 86021, Poitiers Cedex, France.|INSERM, Center for Research in Epidemiology and Population Health (CESP), U1018, Gender, Sexuality and Health Team, Paris-Sud University, UMRS 1018, Villejuif, France.|INSERM CIC-P 1402, La Miletrie University Hospital, Poitiers, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Fritel
authors.affiliation: P' Institute - RoBioSS Unit, Poitiers University - ENSMA, CNRS UPR 3346, Futuroscope, France.
authors.forename: Laetitia
authors.initials: L
authors.lastname: Fradet
authors.affiliation: P' Institute - RoBioSS Unit, Poitiers University - ENSMA, CNRS UPR 3346, Futuroscope, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Decatoire
authors.affiliation: P' Institute - RoBioSS Unit, Poitiers University - ENSMA, CNRS UPR 3346, Futuroscope, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Lacouture
authors.affiliation: INSERM, Center for Research in Epidemiology and Population Health (CESP), U1018, Gender, Sexuality and Health Team, Paris-Sud University, UMRS 1018, Villejuif, France.
authors.forename: Henri
authors.initials: H
authors.lastname: Panjo
authors.affiliation: Department of Obstetrics and Gynecology, La Miletrie University Hospital, 2 rue de la Milétrie CS90577, 86021, Poitiers Cedex, France.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Pierre
authors.affiliation: Department of Obstetrics and Gynecology, La Miletrie University Hospital, 2 rue de la Milétrie CS90577, 86021, Poitiers Cedex, France.|P' Institute - RoBioSS Unit, Poitiers University - ENSMA, CNRS UPR 3346, Futuroscope, France.
authors.forename: David
authors.initials: D
authors.lastname: Desseauve
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008022:Ligaments / Q000000981:diagnostic imaging / Q000503:physiopathology; D008137:Longitudinal Studies; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging / Q000503:physiopathology; D017773:Pelvic Floor / Q000000981:diagnostic imaging / Q000503:physiopathology*; D059952:Pelvic Floor Disorders / Q000000981:diagnostic imaging / Q000209:etiology*; D010502:Perineum / Q000000981:diagnostic imaging / Q000503:physiopathology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011264:Pregnancy Trimesters / Q000502:physiology*; D011446:Prospective Studies; D016216:Ultrasonography, Prenatal / Q000379:methods
keywords: Levator hiatus; Ligamentous laxity; Pelvic floor; Pelvic floor disorders; Pregnancy