Preliminary study of pelvic floor structural changes in early and middle pregnant women with cervical incompetence

doi:10.3969/j.issn.1674-8115.2023.04.008

Abstract

Abstract:

Objective ·To explore the changes of pelvic floor structure in the early and middle pregnant women with the history of cervical incompetence (CIC) by ultrasound. Methods ·The pregnant women during early and middle trimesters were collected from Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine from August 2022 to January 2023. All the pregnant women had only one history of premature delivery, abortion or induced labor in the middle trimester, and were divided into CIC group and control group according to whether having the history of CIC in the previous pregnancy. Age, body mass index (BMI), gestational age, the prevalence of funneling of internal urethral orifice and the prevalence of urinary incontinence were compared between the two groups. Two-dimensional, three-dimensional, and four-dimensional pelvic floor ultrasound was used to measure the pelvic floor structures of the women in the states of resting, pelvic floor muscle contraction (PFMC) and Valsalva maneuver (VM). The parameters of pelvic floor structure included bladder neck position, urethral inclination angle, urethral rotation angle, posterior angle of bladder, bladder neck mobility, cervix position, position of ampulla of rectum, area of urogenital hiatus (HA), hiatal transverse diameter, and hiatal anteroposterior diameter. General linear regression model was used to correct the influence of confounders and to analyze the association between the history of CIC and the different indexes of pelvic floor structure. Results ·A total of 76 pregnant women in early and middle trimesters were collected, including 39 women in the CIC group and 37 women in the control group. There was no significant difference in the age between the two groups, while BMI and gestational age in the CIC group were significantly greater than those of the control group, and the differences were significant (both P<0.05). At the states of resting and PFMC, there were no significant differences in structural parameters (all P> 0.05); at the state of VM, HA (P=0.016) and hiatal anteroposterior diameter (P=0.014) increased in the CIC group, while other parameters did not change significantly. It was found that the CIC history was associated with HA (P=0.038) and hiatal anteroposterior diameter (P=0.049) at VM after adjusting gestational age and BMI by the general linear regression model. The incidence rates of funneling of internal urethral orific in the CIC group and the control group were 10.25% and 0, respectively; the incidence rates of stress incontinence were 23.07% and 13.51%, respectively. Neither of the differences were significant (both P>0.05). Conclusion ·In the pregnant women with the history of CIC, HA and hiatal anteroposterior diameter at VM increase, and the morphological change of the levator ani hiatus is more obvious with the increase of the vertical axis.

Key words: cervical incompetence (CIC), ultrasound examination, pelvic floor, pregnancy, pelvic floor dysfunction (PFD)

CLC Number:

R445.1

HE Ping, SHAO Feixue, GUO Lili, LI Keting, MAO Xiaoyuan, BAO Yirong, WANG Lei. Preliminary study of pelvic floor structural changes in early and middle pregnant women with cervical incompetence[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2023, 43(4): 459-465.

Figures/Tables 8

TrendMD

References 22

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Item	CIC group (n=39)	Control group (n=37)	t/χ² value	P value
Age/year	32.10±3.62	32.19±4.29	0.077	0.939
BMI/(kg·m^-2)	25.29±3.76	22.44±3.13	-3.040	0.004
Gestational age/week	22.68±5.07	16.11±6.56	-4.207	0.000
Urinary incontinence/n(%)	9 (23.07)	5 (13.51)	1.156	0.219
Funneling of internal urethral orifice/n(%)	4 (10.25)	0 (0)	4.006	0.064

Item	CIC group (n=39)	Control group (n=37)	t/χ² value	P value
Age/year	32.10±3.62	32.19±4.29	0.077	0.939
BMI/(kg·m^-2)	25.29±3.76	22.44±3.13	-3.040	0.004
Gestational age/week	22.68±5.07	16.11±6.56	-4.207	0.000
Urinary incontinence/n(%)	9 (23.07)	5 (13.51)	1.156	0.219
Funneling of internal urethral orifice/n(%)	4 (10.25)	0 (0)	4.006	0.064

Item	CIC group (n=39)	Control group (n=37)	t value	P value
Position of bladder neck/mm	27.76±3.44	27.74±2.71	－0.021	0.983
Urethral inclination angle/(°)	19.93±12.16	21.37±11.88	0.448	0.656
Cervical position/mm	35.69±6.60	33.26±8.91	－1.166	0.249
Position of ampulla of rectum/mm	23.66±8.64	22.04±7.33	－0.753	0.455
HA/cm²	12.76±3.24	11.70±2.22	－1.413	0.163
Hiatal transverse diameter/mm	33.83±5.56	34.07±4.08	0.188	0.852
Hiatal anteroposterior diameter/mm	51.66±7.89	49.07±6.38	－1.340	0.186

Item	CIC group (n=39)	Control group (n=37)	t value	P value
Position of bladder neck/mm	27.76±3.44	27.74±2.71	－0.021	0.983
Urethral inclination angle/(°)	19.93±12.16	21.37±11.88	0.448	0.656
Cervical position/mm	35.69±6.60	33.26±8.91	－1.166	0.249
Position of ampulla of rectum/mm	23.66±8.64	22.04±7.33	－0.753	0.455
HA/cm²	12.76±3.24	11.70±2.22	－1.413	0.163
Hiatal transverse diameter/mm	33.83±5.56	34.07±4.08	0.188	0.852
Hiatal anteroposterior diameter/mm	51.66±7.89	49.07±6.38	－1.340	0.186

Item	CIC group (n=39)	Control group (n=37)	t value	P value
HA/cm²	9.90±2.01	9.89±1.95	-0.014	0.988
Hiatal transverse diameter/mm	30.59±4.21	31.22±3.78	0.593	0.555
Hiatal anteroposterior diameter/mm	44.34±6.53	44.74±5.67	0.241	0.810