Predictive instrumental markers of pelvic floor dysfunction in primiparous women

Background. Pelvic organ prolapse, urinary and fecal incontinence and sexual dysfunction are collectively termed “pelvic floor dysfunction”, the main causes of which are pregnancy and childbirth, which leads to decreased pelvic floor muscle strength and increased frequency of urinary incontinence. Studies show that stress urinary incontinence during pregnancy occurs in a significant proportion of women, and these problems may persist and progress in the postpartum period, especially in those who have suffered injuries during childbirth. In addition, women with complications during pregnancy and childbirth experience more pronounced manifestations of sexual dysfunction and delayed resumption of sexual activity. All these factors indicate the need for early screening and diagnosis of pelvic floor dysfunction in women during pregnancy to improve quality of life and prevent subsequent complications. Objective. To identify predictive ultrasound markers of pelvic floor dysfunction in primiparous women after per vias naturales delivery at the antenatal stage. Material and methods. A prospective cohort comparative study was conducted among 40 women of reproductive age before delivery and 6-8 weeks after delivery per vias naturales in occipital presentation of the fetus. The main group consisted of 18 women who still had symptoms of pelvic floor dysfunction at the end of the late postpartum period; the control group included 22 women without clinical manifestations. All patients underwent a gynecological examination with perineometry and ultrasound examination of the pelvic organs before delivery and 6-8 weeks after delivery. Results. In the group of women who had clinical manifestations of pelvic floor dysfunction, a decrease in pelvic floor muscle tone was noted 6-8 weeks after delivery. These women of ten reported urinary disorders, including frequent urination and stress urinary incontinence. During the instrumental study, it was revealed that already in the third trimester of pregnancy, changes in the urethrovesical angle occurred according to ultrasound examination data, and a decrease in the size of the perineal tendon center and a change in the parameters of the thickness of the bulbospongiosus muscle bundles were observed. Conclusion. Non-invasive diagnostic methods can identify the risks of pelvic floor insufficiency even during pregnancy, which will subsequently allow timely treatment of pelvic dysfunctions in women of reproductive age. Active identification of such patients will help reduce the number of surgical interventions and improve the quality of life of women of reproductive age.

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