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Levator co-activation is a significant confounder of pelvic organ descent on Valsalva maneuver.

Örnö, Ann-Kristin LU and Dietz, H (2007) In Ultrasound in Obstetrics & Gynecology 30(3). p.346-350
Abstract
Objective A Valsalva maneuver is used clinically and on imaging in order to determine female pelvic organ prolapse. We have examined the Potential confounding effect of levator co-activation at the time of a Valsalva maneuver and the impact of repetition with biofeedback instruction. Methods Fifty nulliparous women at 36-38 weeks' gestation received 3D/4D translabial ultrasound investigation in the dorsal resting position after bladder emptying. Valsalva maneuvers were recorded initially and after repeated attempts with visual biofeedback both during the maneuver and after, with the operator demonstrating findings on the ultrasound monitor, in order to abolish levator coactivation. Offline analysis was subsequently undertaken. Results... (More)
Objective A Valsalva maneuver is used clinically and on imaging in order to determine female pelvic organ prolapse. We have examined the Potential confounding effect of levator co-activation at the time of a Valsalva maneuver and the impact of repetition with biofeedback instruction. Methods Fifty nulliparous women at 36-38 weeks' gestation received 3D/4D translabial ultrasound investigation in the dorsal resting position after bladder emptying. Valsalva maneuvers were recorded initially and after repeated attempts with visual biofeedback both during the maneuver and after, with the operator demonstrating findings on the ultrasound monitor, in order to abolish levator coactivation. Offline analysis was subsequently undertaken. Results Significant differences between first and optimal Valsalva maneuver were found for bladder neck position, bladder neck descent, hiatal sagittal diameter and hiatal area on Valsalva. In a minority of women (22/50) we observed a reduction in the sagittal hiatal diameter on first Valsalva maneuver, indicating levator co-activation. A reduction in sagittal diameter was seen in only 11/50 after instruction. Levator co-activation was associated with significantly lower bladder neck descent. Conclusion The Valsalva maneuver is frequently accompanied by a pelvic floor muscle contraction. Levator co-activation may be a substantial confounder, reducing pelvic organ descent. Without repetition and digital, auditory or visual biofeedback, women may not perform a correct Valsalva maneuver. Biofeedback markedly reduces the likelihood of levator co-activation but does not abolish it completely. Copyright (c) 2007 ISUOG. Published by John Wiley & Sons, Ltd. (Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
pelvic organ prolapse Valsalva maneuver floor pelvic levator hiatus, levator am, biofeedback, bladder neck descent, ultrasound
in
Ultrasound in Obstetrics & Gynecology
volume
30
issue
3
pages
346 - 350
publisher
John Wiley & Sons
external identifiers
  • wos:000249962300018
  • scopus:34748916458
ISSN
1469-0705
DOI
10.1002/uog.4082
language
English
LU publication?
yes
id
77252b37-9df9-4484-b2b0-c01f84d506f2 (old id 606856)
alternative location
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=17702054&dopt=Abstract
date added to LUP
2007-12-19 10:58:01
date last changed
2017-10-22 04:38:29
@article{77252b37-9df9-4484-b2b0-c01f84d506f2,
  abstract     = {Objective A Valsalva maneuver is used clinically and on imaging in order to determine female pelvic organ prolapse. We have examined the Potential confounding effect of levator co-activation at the time of a Valsalva maneuver and the impact of repetition with biofeedback instruction. Methods Fifty nulliparous women at 36-38 weeks' gestation received 3D/4D translabial ultrasound investigation in the dorsal resting position after bladder emptying. Valsalva maneuvers were recorded initially and after repeated attempts with visual biofeedback both during the maneuver and after, with the operator demonstrating findings on the ultrasound monitor, in order to abolish levator coactivation. Offline analysis was subsequently undertaken. Results Significant differences between first and optimal Valsalva maneuver were found for bladder neck position, bladder neck descent, hiatal sagittal diameter and hiatal area on Valsalva. In a minority of women (22/50) we observed a reduction in the sagittal hiatal diameter on first Valsalva maneuver, indicating levator co-activation. A reduction in sagittal diameter was seen in only 11/50 after instruction. Levator co-activation was associated with significantly lower bladder neck descent. Conclusion The Valsalva maneuver is frequently accompanied by a pelvic floor muscle contraction. Levator co-activation may be a substantial confounder, reducing pelvic organ descent. Without repetition and digital, auditory or visual biofeedback, women may not perform a correct Valsalva maneuver. Biofeedback markedly reduces the likelihood of levator co-activation but does not abolish it completely. Copyright (c) 2007 ISUOG. Published by John Wiley & Sons, Ltd.},
  author       = {Örnö, Ann-Kristin and Dietz, H},
  issn         = {1469-0705},
  keyword      = {pelvic organ prolapse
Valsalva maneuver
floor
pelvic
levator hiatus,levator am,biofeedback,bladder neck descent,ultrasound},
  language     = {eng},
  number       = {3},
  pages        = {346--350},
  publisher    = {John Wiley & Sons},
  series       = {Ultrasound in Obstetrics & Gynecology},
  title        = {Levator co-activation is a significant confounder of pelvic organ descent on Valsalva maneuver.},
  url          = {http://dx.doi.org/10.1002/uog.4082},
  volume       = {30},
  year         = {2007},
}