Changes in cardinal ligament length and curvature with parity and prolapse and their relation to level III hiatus measures
Introduction and hypothesis Test the hypotheses that (1) cardinal ligament (CL) straightening and lengthening occur with parity and prolapse, (2) CL straightening occurs before lengthening, and (3) CL length is correlated with level III measures. Methods We performed a secondary analysis of MRIs fro...
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| Veröffentlicht in: | International Urogynecology Journal 2022-01, Vol.33 (1), p.107-114 |
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| creator | Cheng, Wenjin Thibault, Mary Duarte Chen, Luyun DeLancey, John O. L. Swenson, Carolyn W. |
| description | Introduction and hypothesis
Test the hypotheses that (1) cardinal ligament (CL) straightening and lengthening occur with parity and prolapse, (2) CL straightening occurs before lengthening, and (3) CL length is correlated with level III measures.
Methods
We performed a secondary analysis of MRIs from women in three groups: (1) nulliparous with normal support, (2) parous with normal support, and (3) uterine prolapse (POP-Q point C
>
− 4 and Ba
>
1 cm). The 3D stress MRI images at rest and maximal Valsalva were analyzed. CLs were traced from their origin to cervico-vaginal insertions. Curvature ratio was calculated as curved length/straight length. Level III measures included urogenital hiatus (UGH), levator hiatus (LH), and levator bowl volume (LBV), and their correlations with CL length were calculated.
Results
Ten women were included in each group. Compared to the nulliparous group, CL length was 18% longer in parous controls (
p
= .04) and 59% longer with prolapse (
p
< .01) at rest, while at Valsalva, CL length was 10% longer in parous controls (
p
= .21) and 49% longer with prolapse (
p
< .01). Curvature ratios showed 18% more straightening in women with prolapse compared to parous controls (
p
< .01). Curved CL length and level III measures were moderately to strongly correlated: UGH (rest: R = 0.68,
p
< .01; Valsalva: R =0.80,
p
|
| doi_str_mv | 10.1007/s00192-021-04824-9 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_10519143</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2617112096</sourcerecordid><originalsourceid>FETCH-LOGICAL-c475t-e83569c0165a6c6c3b0590390da3fb92538b4f5673817ba73282aec2b1184ab63</originalsourceid><addsrcrecordid>eNp9UcmOEzEUtBCICYEf4IAsceHS8Ly12yeEIpZII3GBs_XacdIeuRfs7qDh63GSYVgOnCy76pXrVRHynMFrBqDfZABmeAWcVSAbLivzgKyYFKISwMVDsgIjdCVkza_Ik5xvAECCgsfkSkjgjdJiRX5sOhwOPtMwUIdpFwaMNIYD9n6YafTDYe4oDjvqlnTEeUmefg_lacIU5tszMqUx4pT9-TJ3PiSafMQ5jAOdx6Jx9JFut1vahSKQae8xF538lDzaY8z-2d25Jl8_vP-y-VRdf_643by7rpzUaq58I1RtHLBaYe1qJ1pQBoSBHYp9a7gSTSv3qtaiYbpFLXjD0TveMtZIbGuxJm8vutPS9n7nymIJo51S6DHd2hGD_RsZQmcP49EyUMyc8lyTV3cKafy2-DzbPmTnY8TBj0u2xQNTJVOpC_XlP9SbcUkl1MKqmWaMgzlZ4heWS2POye_v3TCwp27tpVtburXnbq0pQy_-3ON-5FeZhSAuhFygUmr6_fd_ZH8C09SwOQ</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2617112096</pqid></control><display><type>article</type><title>Changes in cardinal ligament length and curvature with parity and prolapse and their relation to level III hiatus measures</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Cheng, Wenjin ; Thibault, Mary Duarte ; Chen, Luyun ; DeLancey, John O. L. ; Swenson, Carolyn W.</creator><creatorcontrib>Cheng, Wenjin ; Thibault, Mary Duarte ; Chen, Luyun ; DeLancey, John O. L. ; Swenson, Carolyn W.</creatorcontrib><description><![CDATA[Introduction and hypothesis
Test the hypotheses that (1) cardinal ligament (CL) straightening and lengthening occur with parity and prolapse, (2) CL straightening occurs before lengthening, and (3) CL length is correlated with level III measures.
Methods
We performed a secondary analysis of MRIs from women in three groups: (1) nulliparous with normal support, (2) parous with normal support, and (3) uterine prolapse (POP-Q point C
>
− 4 and Ba
>
1 cm). The 3D stress MRI images at rest and maximal Valsalva were analyzed. CLs were traced from their origin to cervico-vaginal insertions. Curvature ratio was calculated as curved length/straight length. Level III measures included urogenital hiatus (UGH), levator hiatus (LH), and levator bowl volume (LBV), and their correlations with CL length were calculated.
Results
Ten women were included in each group. Compared to the nulliparous group, CL length was 18% longer in parous controls (
p
= .04) and 59% longer with prolapse (
p
< .01) at rest, while at Valsalva, CL length was 10% longer in parous controls (
p
= .21) and 49% longer with prolapse (
p
< .01). Curvature ratios showed 18% more straightening in women with prolapse compared to parous controls (
p
< .01). Curved CL length and level III measures were moderately to strongly correlated: UGH (rest: R = 0.68,
p
< .01; Valsalva: R =0.80,
p
< .01), LH (rest: R = 0.60,
p
< .01; Valsalva: R = 0.78,
p
< .01), and LBV (rest: R = 0.71,
p
< .01; Valsalva: R =0.89,
p
< .01).
Conclusion
Our findings suggest that the CLs undergo three times as much lengthening with prolapse as with parity; however, straightening only occurs with prolapse. Strong correlations exist between level I and level III support.]]></description><identifier>ISSN: 0937-3462</identifier><identifier>EISSN: 1433-3023</identifier><identifier>DOI: 10.1007/s00192-021-04824-9</identifier><identifier>PMID: 34028573</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Biomechanics ; Cervix ; Female ; Gynecology ; Humans ; Hypotheses ; Ligaments ; Ligaments - diagnostic imaging ; Medicine ; Medicine & Public Health ; Obstetrics ; Original Article ; Parity ; Pelvic Floor ; Pelvic Organ Prolapse - diagnostic imaging ; Pelvis ; Pregnancy ; Urology ; Vagina ; Valsalva Maneuver ; Women</subject><ispartof>International Urogynecology Journal, 2022-01, Vol.33 (1), p.107-114</ispartof><rights>The International Urogynecological Association 2021</rights><rights>2021. The International Urogynecological Association.</rights><rights>The International Urogynecological Association 2021.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c475t-e83569c0165a6c6c3b0590390da3fb92538b4f5673817ba73282aec2b1184ab63</citedby><cites>FETCH-LOGICAL-c475t-e83569c0165a6c6c3b0590390da3fb92538b4f5673817ba73282aec2b1184ab63</cites><orcidid>0000-0003-1465-5887</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00192-021-04824-9$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00192-021-04824-9$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>230,314,780,784,885,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34028573$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Cheng, Wenjin</creatorcontrib><creatorcontrib>Thibault, Mary Duarte</creatorcontrib><creatorcontrib>Chen, Luyun</creatorcontrib><creatorcontrib>DeLancey, John O. L.</creatorcontrib><creatorcontrib>Swenson, Carolyn W.</creatorcontrib><title>Changes in cardinal ligament length and curvature with parity and prolapse and their relation to level III hiatus measures</title><title>International Urogynecology Journal</title><addtitle>Int Urogynecol J</addtitle><addtitle>Int Urogynecol J</addtitle><description><![CDATA[Introduction and hypothesis
Test the hypotheses that (1) cardinal ligament (CL) straightening and lengthening occur with parity and prolapse, (2) CL straightening occurs before lengthening, and (3) CL length is correlated with level III measures.
Methods
We performed a secondary analysis of MRIs from women in three groups: (1) nulliparous with normal support, (2) parous with normal support, and (3) uterine prolapse (POP-Q point C
>
− 4 and Ba
>
1 cm). The 3D stress MRI images at rest and maximal Valsalva were analyzed. CLs were traced from their origin to cervico-vaginal insertions. Curvature ratio was calculated as curved length/straight length. Level III measures included urogenital hiatus (UGH), levator hiatus (LH), and levator bowl volume (LBV), and their correlations with CL length were calculated.
Results
Ten women were included in each group. Compared to the nulliparous group, CL length was 18% longer in parous controls (
p
= .04) and 59% longer with prolapse (
p
< .01) at rest, while at Valsalva, CL length was 10% longer in parous controls (
p
= .21) and 49% longer with prolapse (
p
< .01). Curvature ratios showed 18% more straightening in women with prolapse compared to parous controls (
p
< .01). Curved CL length and level III measures were moderately to strongly correlated: UGH (rest: R = 0.68,
p
< .01; Valsalva: R =0.80,
p
< .01), LH (rest: R = 0.60,
p
< .01; Valsalva: R = 0.78,
p
< .01), and LBV (rest: R = 0.71,
p
< .01; Valsalva: R =0.89,
p
< .01).
Conclusion
Our findings suggest that the CLs undergo three times as much lengthening with prolapse as with parity; however, straightening only occurs with prolapse. Strong correlations exist between level I and level III support.]]></description><subject>Biomechanics</subject><subject>Cervix</subject><subject>Female</subject><subject>Gynecology</subject><subject>Humans</subject><subject>Hypotheses</subject><subject>Ligaments</subject><subject>Ligaments - diagnostic imaging</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Obstetrics</subject><subject>Original Article</subject><subject>Parity</subject><subject>Pelvic Floor</subject><subject>Pelvic Organ Prolapse - diagnostic imaging</subject><subject>Pelvis</subject><subject>Pregnancy</subject><subject>Urology</subject><subject>Vagina</subject><subject>Valsalva Maneuver</subject><subject>Women</subject><issn>0937-3462</issn><issn>1433-3023</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9UcmOEzEUtBCICYEf4IAsceHS8Ly12yeEIpZII3GBs_XacdIeuRfs7qDh63GSYVgOnCy76pXrVRHynMFrBqDfZABmeAWcVSAbLivzgKyYFKISwMVDsgIjdCVkza_Ik5xvAECCgsfkSkjgjdJiRX5sOhwOPtMwUIdpFwaMNIYD9n6YafTDYe4oDjvqlnTEeUmefg_lacIU5tszMqUx4pT9-TJ3PiSafMQ5jAOdx6Jx9JFut1vahSKQae8xF538lDzaY8z-2d25Jl8_vP-y-VRdf_643by7rpzUaq58I1RtHLBaYe1qJ1pQBoSBHYp9a7gSTSv3qtaiYbpFLXjD0TveMtZIbGuxJm8vutPS9n7nymIJo51S6DHd2hGD_RsZQmcP49EyUMyc8lyTV3cKafy2-DzbPmTnY8TBj0u2xQNTJVOpC_XlP9SbcUkl1MKqmWaMgzlZ4heWS2POye_v3TCwp27tpVtburXnbq0pQy_-3ON-5FeZhSAuhFygUmr6_fd_ZH8C09SwOQ</recordid><startdate>20220101</startdate><enddate>20220101</enddate><creator>Cheng, Wenjin</creator><creator>Thibault, Mary Duarte</creator><creator>Chen, Luyun</creator><creator>DeLancey, John O. L.</creator><creator>Swenson, Carolyn W.</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-1465-5887</orcidid></search><sort><creationdate>20220101</creationdate><title>Changes in cardinal ligament length and curvature with parity and prolapse and their relation to level III hiatus measures</title><author>Cheng, Wenjin ; Thibault, Mary Duarte ; Chen, Luyun ; DeLancey, John O. L. ; Swenson, Carolyn W.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c475t-e83569c0165a6c6c3b0590390da3fb92538b4f5673817ba73282aec2b1184ab63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Biomechanics</topic><topic>Cervix</topic><topic>Female</topic><topic>Gynecology</topic><topic>Humans</topic><topic>Hypotheses</topic><topic>Ligaments</topic><topic>Ligaments - diagnostic imaging</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Obstetrics</topic><topic>Original Article</topic><topic>Parity</topic><topic>Pelvic Floor</topic><topic>Pelvic Organ Prolapse - diagnostic imaging</topic><topic>Pelvis</topic><topic>Pregnancy</topic><topic>Urology</topic><topic>Vagina</topic><topic>Valsalva Maneuver</topic><topic>Women</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Cheng, Wenjin</creatorcontrib><creatorcontrib>Thibault, Mary Duarte</creatorcontrib><creatorcontrib>Chen, Luyun</creatorcontrib><creatorcontrib>DeLancey, John O. L.</creatorcontrib><creatorcontrib>Swenson, Carolyn W.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>International Urogynecology Journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Cheng, Wenjin</au><au>Thibault, Mary Duarte</au><au>Chen, Luyun</au><au>DeLancey, John O. L.</au><au>Swenson, Carolyn W.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Changes in cardinal ligament length and curvature with parity and prolapse and their relation to level III hiatus measures</atitle><jtitle>International Urogynecology Journal</jtitle><stitle>Int Urogynecol J</stitle><addtitle>Int Urogynecol J</addtitle><date>2022-01-01</date><risdate>2022</risdate><volume>33</volume><issue>1</issue><spage>107</spage><epage>114</epage><pages>107-114</pages><issn>0937-3462</issn><eissn>1433-3023</eissn><abstract><![CDATA[Introduction and hypothesis
Test the hypotheses that (1) cardinal ligament (CL) straightening and lengthening occur with parity and prolapse, (2) CL straightening occurs before lengthening, and (3) CL length is correlated with level III measures.
Methods
We performed a secondary analysis of MRIs from women in three groups: (1) nulliparous with normal support, (2) parous with normal support, and (3) uterine prolapse (POP-Q point C
>
− 4 and Ba
>
1 cm). The 3D stress MRI images at rest and maximal Valsalva were analyzed. CLs were traced from their origin to cervico-vaginal insertions. Curvature ratio was calculated as curved length/straight length. Level III measures included urogenital hiatus (UGH), levator hiatus (LH), and levator bowl volume (LBV), and their correlations with CL length were calculated.
Results
Ten women were included in each group. Compared to the nulliparous group, CL length was 18% longer in parous controls (
p
= .04) and 59% longer with prolapse (
p
< .01) at rest, while at Valsalva, CL length was 10% longer in parous controls (
p
= .21) and 49% longer with prolapse (
p
< .01). Curvature ratios showed 18% more straightening in women with prolapse compared to parous controls (
p
< .01). Curved CL length and level III measures were moderately to strongly correlated: UGH (rest: R = 0.68,
p
< .01; Valsalva: R =0.80,
p
< .01), LH (rest: R = 0.60,
p
< .01; Valsalva: R = 0.78,
p
< .01), and LBV (rest: R = 0.71,
p
< .01; Valsalva: R =0.89,
p
< .01).
Conclusion
Our findings suggest that the CLs undergo three times as much lengthening with prolapse as with parity; however, straightening only occurs with prolapse. Strong correlations exist between level I and level III support.]]></abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>34028573</pmid><doi>10.1007/s00192-021-04824-9</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0003-1465-5887</orcidid><oa>free_for_read</oa></addata></record> |
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| language | eng |
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| source | MEDLINE; SpringerLink Journals - AutoHoldings |
| subjects | Biomechanics Cervix Female Gynecology Humans Hypotheses Ligaments Ligaments - diagnostic imaging Medicine Medicine & Public Health Obstetrics Original Article Parity Pelvic Floor Pelvic Organ Prolapse - diagnostic imaging Pelvis Pregnancy Urology Vagina Valsalva Maneuver Women |
| title | Changes in cardinal ligament length and curvature with parity and prolapse and their relation to level III hiatus measures |
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