Ultrasound Diagnosis of Levator Ani Hiatus Enlargement and Cystocele in Standing and Supine Positions in the Postpartum Period

Objectives: The aim of this study was to compare the anteroposterior length of levator ani hiatus, as well as the presence and the degree of cystocele in women at risk of pelvic floor dysfunction during the postpartum period by transperineal ultrasound performed in the standing and supine positions. Methods: This was a cross-sectional study including women who delivered vaginally, at risk of pelvic floor dysfunction. After 8–12 weeks postpartum, each woman underwent pelvic floor ultrasound in both standing and supine positions during the Valsalva maneuver to measure the length of hiatal anteroposterior diameter and the cystocele. Demographic and clinical data on pregnancy and delivery were recorded. Women were interviewed to collect subjective symptoms of urinary stress incontinence. Results: The study involved 100 women at risk of pelvic floor dysfunction following a vaginal delivery. The proportion of women with an anteroposterior hiatal diameter ≥60 mm was significantly higher when measured standing than when measured supine (64.0 vs 47.0%, P =.016). Similarly, the frequency of cystocele detected in the standing position was higher than in the supine position (48.0 vs 17.0%, P <.001). The non-agreement between the examinations performed in these two positions was proved by the value of Cohen's Kappa (0.36, 95% CI: 0.22–0.51). Also, in the subgroup of asymptomatic women, more cases of cystocele were detected in the standing position (29 cases, 39.2%) than in the supine position (12 cases, 16.2%) (P =.003). Conclusions: Our study shows that transperineal pelvic floor ultrasound in the postpartum period performed in the standing position, compared with the supine position, achieved a higher detection rate of cystocele and enlarged anteroposterior hiatal diameter in women at risk of pelvic floor dysfunction. These findings should be considered when evaluating the criteria to select candidates for pelvic floor rehabilitation.