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Pelvic floor trauma: does the second baby matter?

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dc.contributor.author Horak, T
dc.contributor.author Guzman-Rojas, R
dc.contributor.author Shek, K
dc.contributor.author Dietz, H
dc.date.accessioned 2017-03-23T13:15:05Z
dc.date.available 2017-03-23T13:15:05Z
dc.date.issued 2014
dc.identifier.citation Ultrasound Obstet Gynecol. 2014 Jul;44(1):90-94 es_CL
dc.identifier.uri http://dx.doi.org/10.1002/uog.13252 es_CL
dc.identifier.uri http://hdl.handle.net/11447/1050
dc.description.abstract OBJECTIVE: To ascertain the effect of a second delivery on pelvic floor anatomy. METHODS: This was a retrospective analysis of data obtained in two perinatal imaging studies. Women were invited for antenatal and two postnatal appointments. All had answered a standardized questionnaire and undergone a clinical examination and translabial four-dimensional ultrasound. Ultrasound volumes were acquired at rest, on Valsalva maneuver and on pelvic floor muscle contraction, and analyzed by postprocessing on a PC. Avulsion was diagnosed on tomographic ultrasound imaging. This study reports data obtained in those women who delivered a second child between the first and second postnatal assessments. RESULTS: Of 715 participants, 94 reported a second birth at their second postnatal appointment on average 2.7 years after their first birth; 65 had a vaginal delivery and 29 a Cesarean section. There were nine attempts at vaginal birth after Cesarean section (VBAC), of which six were successful. When we analyzed the ultrasound findings before and after a second delivery, there was no significant change observed in bladder-neck descent, cystocele descent and hiatal area on Valsalva. Delivery mode of the second birth seemed to have little effect on changes observed between follow-ups, although there was a trend towards increased bladder-neck descent in women after vaginal delivery. On reviewing patients diagnosed with avulsion at their 2-3-year visit and comparing them with findings at the first follow-up visit, we found identical (normal) findings in 87 cases. In five there was an unchanged avulsion. In one case, findings had improved from complete to partial avulsion. There was one new avulsion, in a patient who had delivered her first baby by emergency Cesarean section and her second by vacuum delivery. CONCLUSIONS: A second pregnancy and delivery do not seem to have a major effect on bladder support and/or levator function. However, we documented a case of major levator trauma after VBAC. The issue of pelvic floor trauma after VBAC may have to be investigated further. es_CL
dc.format.extent 5 es_CL
dc.language.iso en_US es_CL
dc.publisher John Wiley & Sons es_CL
dc.subject Avulsion es_CL
dc.subject Birth trauma es_CL
dc.subject Childbirth es_CL
dc.subject Levator ani es_CL
dc.subject Puborectalis muscle es_CL
dc.subject Ultrasound es_CL
dc.title Pelvic floor trauma: does the second baby matter? es_CL
dc.type Artículo es_CL


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