Evaluating the effects of levator ani muscle injury with pelvic organ prolapsed rehabilitation efficacy by transperineal three-dimensional tomographic ultrasonography imaging

Objective To evaluate the rehabilitation efficacy on levator ani muscle(LAM) injury with the measurements of ultrasonic parameters of the hiatus of LAM by transperineal three dimensional ultrasound tomography (TUI) in patients with postpartum POP. Methods From March 2016 to October 2016, 86 patients with POP after vaginal delivery in Maternity and Child health Care Hospital of Longgang District were collected. Patients were divided into rehabilitation group (R) and functional exercise group (F) according to their preference on pelvic floor rehabilitation treatment (43 cases in each group). TUI method was used to determine the presence of LAM injury, and then all patients were divided into two subgroups: the non-injury group and the injury group (R0, R1 and F0, F1). After eighth weeks postpartum, the patients in group R began to undergo 8 weeks of pelvic floor electrical stimulation and family vaginal dumbbell exercise. The patients in group F underwent the pelvic floor exercise for 8 weeks at home. Patients were examined by transperineal three-dimensional ultrasound under the state of resting, valsalva, and contraction after 6~8 weeks postpartum (before treatment) and 18 weeks postpartum (after treatment) respectively. Results TUI imaging showed that 35 cases were complicated with LAM injury. There was no significant difference in the incidence of LAM injury between the group R and group F (41.9% vs 39.5%, χ2=0.048, P=0.826). There was no significant difference (all P>0.05) in the POP-Q degree between the injury group (R1, F1) and the non-injury group (R0, F0) on 6-8 weeks postpartum (before treatment). The improvement rates of POP in group R, R0, R1 were significantly higher than that in group F, F0, F1 (χ2=15.480, 7.441, 8.632; all P<0.01). After treatment, the levator hiatal area under the states of resting and valsalva; the anteroposterior diameter under the states of valsalva; and the levator hiatal area, left-right diameter, anteroposterior diameter under the state of contraction in subgroup R1 were less than those in subgroup F1 (t=-3.285, -3.423, -2.328, -3.706, -2.221 -3.810; all P<0.05). The levator hiatal area, anteroposterior diameter of the hiatus muscle under the state of resting; the levator hiatal area, left-right diameter, anteroposterior diameter under the states of valsalva and contraction in subgroup R0 were less than those in subgroup F0, the differences were statistically significant (t=-3.656, -2.464, -3.886, -2.710, -4.079, -6.769, -4.985, -5.495; all P<0.05). Conclusions There was no significant correlation between the LAM injury and the degree of POP-Q in early stage postpartum. Rehabilitation therapy can promote the recovery of hiatus in the patients with or without LAM injury, and then improve the situation of pelvic organ prolapse in postpartum. TUI can be used to provide an objective, accurate, quantitative reference basis for its assessment of rehabilitation efficacy. Key words: Ultrasonography; Pelvic organ prolapse; Levator ani muscle; Rehabilitation; Transperineal