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Observational Study
. 2021 Jul;32(7):1839-1846.
doi: 10.1007/s00192-021-04783-1. Epub 2021 Apr 17.

An ultrasound observation study on the levator hiatus with or without diastasis recti abdominis in postpartum women

Peng Tian #  1   2 , Dong Mei Liu #  1 , Chao Wang  1 , Yu Gu  1 , Guo Qing Du  3 , Jia Wei Tian  4
Affiliations
Observational Study

An ultrasound observation study on the levator hiatus with or without diastasis recti abdominis in postpartum women

Peng Tian et al. Int Urogynecol J. 2021 Jul.

Abstract

Introduction and hypothesis: We hypothesized that differences in post-partum levator hiatus (LH) measurements, as well as the area of urethra and bladder (AUB), viewed under ultrasound, correlate with diastasis rectus abdominis (DRA) occurrence. The primary objective of this study is to determine ultrasound parameters available for diagnosing DRA in post-partum women. We compared LH and AUB measurements under ultrasound in primiparous women, with and without DRA, at 24-26 weeks postpartum.

Methods: One hundred ninety-four women underwent routine examination, including a self-made clinical symptoms questionnaire, DRA evaluation, and LH and AUB measurements. Independent samples t- and chi-squared tests were used to compare the differences between women with and without DRA.

Results: DRA incidence was significantly higher among those who underwent cesarean section (CS) than for vaginal delivery (VD) (P = 0.038). DRA patients could potentially have urinary urgency, frequency, pain, dysuria, and perineal tears. Additionally, statistically significant differences were found between VD patients, with or without DRA, in the resting LH transverse diameter (TrD) (P = 0.032) and the area of the levator hiatus (ALH) (P = 0.048) as well as AUB at Valsalva (P = 0.049). No differences, however, were found between the DRA and no DRA groups for all those measurements among women who had cesarean deliveries.

Conclusions: DRA was more likely in post-CS women. Furthermore, the results showed a plausible association between DRA occurrence and LH expansion, especially in women with VD under rest and Valsalva. This could be useful for developing therapeutic plans based on these parameters for post-partum rehabilitation of women with DRA to avoid long-term complications.

Keywords: Diastasis recti abdominis; Levator hiatus; Mode of delivery; Ultrasound.

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Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
Flowchart
Fig. 2
Fig. 2
Ultrasound images of the inter-rectus distance at 5 cm above (a), 2 cm above (b), and 2 cm below (c) the umbilicus. R: Rectus abdominis. Yellow line: Measurement between the two rectus abdominis muscles at the low edge of the connection
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