Association Between Sonographic Deviations in the Perineum and Symptoms of a Deficient Perineum in Primiparous Women One Year After Birth: A Prospective Cohort Study

Objectives This study aimed to investigate whether primiparous women with sonographic deviations in the muscles fusing into the perineal body reported more symptoms of deficient perineum than women without deviations 1 year after birth. Design Non-consecutive prospective cohort study. Setting Akershus University Hospital, Norway. Population Three hundred and eighty-eight primiparas. Methods Women were examined 1 year after birth using three-dimensional endovaginal and endoanal ultrasound with a high-resolution probe. In the blinded analysis, the transverse perineal, the puboperinealis and the puboanalis muscles were identified where they fuse into the perineal body and assessed for deviations. Symptoms of deficient perineum were evaluated using the 'Karolinska Symptoms After Perineal Teras Inventory' (KAPTAIN). Main Outcome Measures Symptoms of a deficient perineum, assessed using two outcomes: the median total score of KAPTAIN and a KAPTAIN score >= 8 1 year postpartum. Results Sonographic deviations in one or more of the muscles fusing into the perineal body 1 year after birth were observed in 168 participants (43.3%). Of these, 54 (32.1%) reported a KAPTAIN score >= 8. The median KAPTAIN score was 6.0 (IQR 3.0-9.0) in the group with sonographic deviations and 4.0 (IQR 2.0-6.0) in women with a sonographically intact perineum (p > 0.001). The unadjusted and adjusted odds ratio (OR) for reporting a KAPTAIN score >= 8 was 2.9 (95% CI 1.7-4.7) and 2.3 (95% CI 1.2-4.2), respectively, when comparing women with sonographic deviations to those with no sonographic deviations. Conclusion Our results indicate that sonographic deviations of the perineal body are associated with symptoms of a deficient perineum in primiparous women 1 year after birth.