Disfunções do assoalho pélvico em primíparas após parto vaginal: associação entre avaliação clínica e ultrassonográfica

Abstract

Introduction: Disorders related to the pelvic floor include a common group of pathological conditions, with pregnancy and childbirth recognized as one of the major risk factors. Objective: To evaluate the pelvic floor dysfunctions in primiparous women after vaginal delivery and the association between risk factors, clinical examination and three-dimensional ultrasonography. Methods: This is a prospective observational cohort study conducted from March 2016 to December 2016. The 773 vaginal deliveries of primiparous that occurred between January 2013 and December 2015 were selected for the study. Clinical and obstetric data of interest were obtained from the clinical database of the Hospital das Clínicas - UFMG, and medical records. All patients included in the study underwent detailed anamnesis, questionnaire application, physical examination and endovaginal and endoanal three-dimensional ultrasonography. Results: 698 patients were contacted and 50 were evaluated. Sexual dysfunction (SD) was the most prevalent PFD (64.6%), followed by urinary incontinence (UI) representing 42% and anal incontinence (AI) 36%. When associated with clinical features and PFD, oxytocin use increased by approximately 4 times the odds of UI (OR = 4.182) and in the multivariate analysis, the odds of UI were increased in forceps use by approximately 11 times (OR 11.552). The other clinical characteristics were not statistically significant for PFD. When the clinical and obstetrical predictors for PFD were associated with threedimensional ultrasound (US3D), forceps increased the odds of lesion diagnosed by US3D in 6-fold (OR 6.000) and in multivariate analysis; forceps again increased the odds of injury in approximately 7 times (OR 7.788). The other clinical characteristics and PFD were not statistically significant for US3D lesions. Conclusion: Sexual dysfunction was the most frequent pelvic floor dysfunction in primiparous after vaginal delivery in a longterm follow-up. The use of forceps in primiparous was associated with a greater chance of urinary incontinence and pelvic floor muscle damage diagnosed by three-dimensional ultrasonography.