Analysis of pelvic floor musculature function during pregnancy and postpartum: a cohort study: (a prospective cohort study to assess the PFMS by perineometry and digital vaginal palpation during pregnancy and following vaginal or caesarean childbirth).

AIM: To compare the measurements of women's pelvic floor musculature strength (PFMS) during pregnancy and postpartum period.

BACKGROUND

Pregnancy and childbirth can have an influence on the muscles and pelvic floor and can cause morbidities of women's genito-urinary tract.

DESIGN

A prospective cohort study.

METHODS

There were included 226 primigravidae women, attended by community health services in the city of Itapecerica da Serra, Sao Paulo, Brazil. The participants were followed in four stages: (1) within 12 weeks of pregnancy; (2) between 36-40 weeks of pregnancy; (3) within 48 hours after childbirth; (4) 42-60 days after childbirth. Data were collected from February 2007-August 2008. The pelvic floor musculature strength was evaluated by perineometry and digital vaginal palpation in stages 1, 2 and 4. The final sample included 110 women who completed all four stages of the study.

RESULTS

The pelvic floor musculature strength of the women did not change significantly during pregnancy or after delivery (anova: p = 0·78). In all three examined stages, a low-intensity pelvic floor musculature strength was prevalent (in mmHg: stage 1 = 15·9; stage 2 = 15·2, stage 4 = 14·7), with scores from 0-3 on the Oxford scale. The pelvic floor musculature strength did not differ in relation to maternal age, skin colour, conjugal status, dyspareunia, stool characteristics, type of delivery, or conditions of the perineum. An interaction between maternal nutritional state and newborn's weight may affect the pelvic floor musculature strength (manova: p = 0·04).

CONCLUSION

Pregnancy and childbirth did not reduce significantly pelvic floor musculature strength. The perineometry and digital vaginal palpation used to assess the pelvic floor musculature strength were well accepted by the women.

RELEVANCE TO CLINICAL PRACTICE: In clinical practice, digital vaginal palpation is effective for supporting the diagnosis of urinary, intestinal and sexual dysfunctions. Perineometry use is particularly important together with the performance of perineal exercises with biofeedback in the treatment these disorders.