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Friday, May 16, 2014

Impact of levator trauma on pelvic floor muscle function


Rojas RG, Wong V, Shek KL, Dietz HP. Int Urogynecol J 2014;25:375-380.

Beth Shelly PT, DPT, WCS, BCB PMD
May 7, 2014 Pelvic PT Distance Journal Club

Method - 433 primips, Blinded measurements before and after delivery
·         Questionnaires
·         MMT by Oxford scale
·         4D translabial US (specifics on page 377)

Macrotrauma = levator avulsion
·         15% of parous women
·         Defined as puborectalis insertion of all three central segments of US were abnormal.

Microtrauma = overdistention of levator hiatus
·         21%  of vaginal deliveries
·         Defined as increase of over 20% in hiatus during valsalva comparing pre to post delivery
·         May be related to
o   Over stretching of connective tissue
o   Overstretching of PFM
o   Changes in resting tone, baseline cortical activation
o   Changes in neuromuscular pathways
 

Results
·         All postpartum women (table 3 page 377)
o   Decrease in all US measurements
o   No change on MMT
o   MMT was associated with delivery mode  
·         Comparing avulsion to no avulsion (table 4 page 378)
o   Only sig measure was MMT
·         Comparing microtrauma to no microtrauma (excluding avulsion) (table 5 page 378)
o   Only sig measure was MMT
 
Conclusion - although US does show changes in PFM postpartum, MMT was more sensitive in measuring contractive function in women with avulsion and hiatal over distention

 ICS abstracts Barcelona 2014 - #8 Conservative management abstract award -  Kari Bo

 Post partum women with and without major levator ani defect.
·         6 weeks post partum 175 randomized to PFM training or usual care. 
·         Both groups were trained on PFM contraction.
·         Treatment group did weekly PFM training classes for 4 months and was encouraged to do PFM exercises at home.
·         Control group only received one instruction. 

No effect of PFMT for UI in either women with or without major levator ani defect. There were some small difference in group outcomes favoring the PFM training  group but they did not reach statistical sig.  No difference in PFM strength, endurance, or vaginal resting pressure.  Presence of defect did not change effect of training.

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