Purpose
To compare MR imaging findings in the pubic symphysis of postpartum women with vaginal birth and caesarian section.
Methods and Materials
The institutional review board approved the study,
and informed consent was provided by all participants. A total of 30 healthy women (mean age 34.2 years) in the early postpartum period (within one week) were examined with MRI.
Two groups (17 women with vaginal birth and 13 with caesarian section) were compared with regard to MRI changes of the pubicsymphysis (presence and extent of bone marrow edema,
fluid in the joint gap,
fractures,
ligamentous changes,
sclerosis and cysts).
Two musculoskeletal radiologists blinded to clinical information assessed...
Results
The prevalence of bone marrow edema was high in both groups (13/17(76.5%) vaginal deliveries and 10/13(76.9%) cesarean deliveries) for reader 1 (p=0.992) and 14/17(82.4%) and 10/13(76.9%) for reader 2 (p=0.762).
There were no significant differences regarding the extension of bone marrow edema (reader 1: right side 2.5±3.3mm vs.
6.3±7.3mm,
p=0.300; left side 3.4±4.1mm vs.
4.1±4.6mm,
p=0.837) and the presence of fluid in the joint gap (4/17(23.5%) vs.
2/13 (15.4%) (p=0.580) for reader 1 (similar for reader 2)).
Futhermore no significant differences were found regarding ligamentous...
Conclusion
This study shows a comparably high prevalence of bone marrow edema in pubic bones (3 of 4 women) after uncomplicated childbirth,
either by vaginal delivery or by planned cesarean section.
The same also applies to the incidence of structural changes such asjoint distention and joint effusion in the pubic joint.
We think these findings to be primarily resulting from chronic increased mechanical stress to the pelvic ring during pregnancy.
This substantiates our initial hypothesis that women after planned cesarean section may demonstrate significant stress induced...
References
1. Brandon C,
Jacobson JA,
Low LK,
Park L,
DeLancey J,
Miller J.
Pubic bone injuries in primiparous women: magnetic resonance imaging in detection and differential diagnosis of structural injury.
Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology.
2012; 39(4):444-451.
2.
Miller JM,
Brandon C,
Jacobson JA,
Low LK,
Zielinski R,
Ashton-Miller J,
et al.
MRI findings in patients considered high risk for pelvic floor injury studied serially after vaginal childbirth.
AJR American journal...
Personal Information
Dr.
med.
Christoph Metzler.
E-mail:
[email protected].
Kantonsspital Winterthur,
8401 Winterthur,
Switzerland.