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Obstetrics & Gynecology 2006;108:879-883
© 2006 by The American College of Obstetricians and Gynecologists
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ORIGINAL RESEARCH

Quantification of Levator Ani Cross-Sectional Area Differences Between Women With and Those Without Prolapse

Yvonne Hsu, MD, Luyun Chen, MS, Markus Huebner, MD, James A. Ashton-Miller, PhD and John O.L. DeLancey, MD

From the University of Michigan, Ann Arbor, Michigan.

OBJECTIVE: Compare levator ani cross-sectional area as a function of prolapse and muscle defect status.

METHODS: Thirty women with prolapse and 30 women with normal pelvic support were selected from an ongoing case-control study of prolapse. For each of the two groups, 10 women were selected from three categories of levator defect severity: none, minor, and major identified on supine magnetic resonance scans. Using those scans, three-dimensional (3D) models of the levator ani muscles were made using a modeling program (3D Slicer), and cross-sections of the pubic portion were calculated perpendicular to the muscle fiber direction using another program, I-DEAS. An analysis of variance was performed.

RESULTS: The ventral component of the levator muscle of women with major defects had a 36% smaller cross-sectional area, and women with minor defects had a 29% smaller cross-sectional area compared with the women with no defects (P<.001). In the dorsal component, there were significant differences in cross-sectional area according to defect status (P=.03); women with major levator defects had the largest cross-sectional area compared with the other defect groups. For each defect severity category (none, minor, major), there were no significant differences in cross-sectional area between women with and those without prolapse.

CONCLUSION: Women with visible levator ani defects on magnetic resonance imaging had significantly smaller cross-sectional areas in the ventral component of the pubic portion of the muscle compared with women with intact muscles. Women with major levator ani defects had larger cross-sectional areas in the dorsal component than women with minor or no defects.

LEVEL OF EVIDENCE: II-2






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