Change in levator ani muscle stiffness and active force during pregnancy and post-partum
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ORIGINAL ARTICLE
Change in levator ani muscle stiffness and active force during pregnancy and post-partum Melissa J. Davidson 1
&
Poul M. F. Nielsen 1,2 & Andrew J. Taberner 1,2 & Jennifer A. Kruger 1,3
Received: 26 March 2020 / Accepted: 3 August 2020 # The International Urogynecological Association 2020
Abstract Introduction and hypothesis It is assumed changes occur to the biomechanics and viscoelastic response of the levator ani muscle during pregnancy; however, there is limited evidence of this. This study used instrumentation and clinical measures to determine the stiffness and active force capacity of levator ani muscle during pregnancy and post-partum, investigated any associations with delivery outcomes, and explored the biomechanical properties associated with symptoms of pelvic floor dysfunction. Methods This was a prospective observational study, with nulliparous women with a singleton low-risk pregnancy. Data were collected at two stages during pregnancy and post-partum. Measurements included the Australian Pelvic Floor Questionnaire, palpation of active force, and elastometry measurements. Post-partum, 3D/4D ultrasound measurements were included. Repeated measures ANOVAs, pairwise comparisons, Pearson correlation coefficients, and Student’s t-tests were used as appropriate. Results Fifty-nine women took part in the study. Active force was significantly different over the pregnancy and post-partum, measured with instrumentation (p = 0.002) and palpation (p = 0.006 right, p = 0.029 left). There was no significant change in muscle stiffness during pregnancy. Post-partum muscle stiffness was significantly different between women who gave birth vaginally vs. caesarean section (p = 0.002). Post-partum there were differences in levator hiatal area, symptoms of bladder dysfunction, prolapse symptoms, and sexual dysfunction symptoms. Conclusions Active force of the levator ani muscle was significantly reduced during pregnancy and in the post-partum period, while muscle stiffness reduced only in those who had vaginal deliveries. Keywords Muscle stiffness . Active force . Pregnancy . Temporal changes . Levator ani muscle
Introduction It is well understood that significant physiological changes occur during pregnancy and delivery, including increased vaginal distensibility, pelvic fascia lengthening, and reduced ligament stiffness [1, 2]. During delivery, computational models estimate stretch ratios of between 2.2 to 4.3 for the
* Melissa J. Davidson [email protected] 1
Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
2
Department of Engineering Science, University of Auckland, Auckland, New Zealand
3
Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
levator ani muscles (LAM) [3]. Due to the large forces developed during stretching, avulsion of the LAM from the pubic bone occurs in up to 35% of women [4] increasing their risk of developing pelvic floor dysfunction [5]. Skeletal muscles typically fail at 50% strain [6]. However,
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