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Effect of pelvic position on ultrasonic measurement parameters of pelvic floor in postpartum women

BMC Women's Health volume 25, Article number: 184 (2025) Cite this article

Abstract

Objective

To analyse the effect of pelvic position on ultrasonic measurement parameters of pelvic floor in postpartum women.

Methods

This study included 132 postpartum participants who visited Fujian Maternity and Child Health Hospital from May 2020 to May 2024. All participants were assessed by medical professionals for general information and pelvic floor four dimensional ultrasound. Ultrasonic measurements were performed in three different positions of the pelvis (anterior pelvic tilt, posterior pelvic tilt, and neutral pelvic tilt) based on lithotomy position.

Results

Our results indicated that the differences in the diagnosis of cystocele, uterine prolapse, perineal overactivity, and hiatal ballooning among the neutral position, anterior pelvic tilt, and posterior pelvic tilt were statistically significant (P<.001, P<.001, P<.001, and P<.001 respectively). The differences among neutral pelvic tilt, anterior pelvic tilt, and posterior pelvic tilt in hiatal area (during contraction), hiatal area (during rest), hiatal area (during valsalva), bladder neck descent, urethral rotation angle, cervical descent, rectal ampulla descent, hiatal area increase, and hiatal area decrease were statistically significant (P <.001, P <.001, P <.001, P <.001, P <.001, P <.001, P <.001, P <.001, and P <.001 respectively), with almost all the values of those parameters in posterior pelvic tilt the highest among three groups. The differences in cervical position (at rest), rectal ampulla position (at rest), and bladder neck position (during valsalva), cervical position (during valsalva), and rectal ampulla position (during valsalva) among neutral pelvic tilt, anterior pelvic tilt, and posterior pelvic tilt were statistically significant (P <.001, P =.035, P <.001, P <.001, and P <.001 respectively), with almost all the values of those parameters in posterior pelvic tilt the lowest among three groups.

Conclusion

During the pelvic floor muscle contraction, the posterior pelvic tilt showed the most reduction of hiatal area compared to that in other positions. During Valsalva, not only the most increase of the hiatal area, but also the greatest bladder neck descent, cervical neck descent, and rectal ampulla descent were observed in the posterior pelvic tilt position.

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Introduction

Pelvic organ prolapse (POP) is defined as the descent of the uterus and/or the different vaginal compartments and their neighbouring organs, such as the bladder, rectum or bowel [1]. Age, vaginal delivery, parity, birthweight, age, and body mass index are common risk factors for POP [2]. A systematic review of papers published from 2009 to 2021 has revealed that the total prevalence of POP is 30.9%, with 25.0% reported via questionnaire estimation and 41.8% reported via physical examination [3]. POP is closely related to difficulty defecating, lower abdominal pain, and difficulty voiding, resulting in functional limitations in daily life [4, 5]. The cost of POP to individuals and to society is considerable in terms of productivity [6]. A detailed and accurate examination is necessary and important to determine whether there is prolapse and the severity of the prolapse before treatment.

In recent years, ultrasound has become increasingly popular in the diagnosis of POP because of its high reliability and economic acceptability [7,8,9]. Pelvic floor muscle (PFM) contraction and the Valsalva manoeuvre are important in the evaluation of POP. On the basis of the definition of the reference point (inferoposterior margin of the symphysis pubis), POP is diagnosed through observing the descent of the urethra, bladder, cervix, and rectum during the Valsalva manoeuvre [10]. The ability of the subject to perform the Valsalva manoeuvre well during the test could lead to different diagnoses. Pelvic floor prolapse may be misdiagnosed or missed due to poorer or better performance in the Valsalva manoeuvre, and PFM contraction may be affected by the pelvic position. Few women have reduced pelvic floor perception and are unable to complete PFM contraction or cannot relax their PFM voluntarily [11, 12]. Studies have reported that measurements of organ descent are greater in the standing position than in the lithotomy position [13, 14]. This result is not surprising, as the pelvic floor receives greater pressure in the standing position. Other studies have reported that PFM activity changes in different pelvic positions [15, 16]. However, no studies on the effects of the pelvic position on PFM contraction and the Valsalva manoeuvre have been reported thus far. Our hypothesis is that the ultrasonic parameters of the pelvic floor is affected by the position of the pelvis. To better observe the changes that the pelvic position may make, women in the postpartum period were selected as participants in the present study because these women would have a relaxed pelvic floor compared with those who are nulliparous. Therefore, the aim of the present study was to evaluate the effects of the pelvic position on the ultrasonic measurement parameters of the pelvic floor in postpartum women via pelvic floor 4-dimensional (4D) ultrasound.

Materials and methods

Participants

The present study included 132 participants who visited Fujian Maternity and Child Health Hospital from May 2020 to May 2024. General information, including age, height, weight, BMI (body mass index), gestational weight gain, neonatal weight, gestation, parturition, education, and delivery mode, was collected by medical professionals for all participants who signed the consent form. The inclusion criteria were as follows: participants who had a vaginal birth and who were 2 years within the postpartum period and could tolerate a gynaecological examination. The exclusion criteria were participants with gynaecologic bleeding, those suspected of being pregnant, those who could not perform the Valsalva manoeuvre, and those who had a history of pelvic floor surgery that may affect the results of the assessment. This study has been approved by the Ethics Committee of Fujian Maternity and Child Health Hospital (No. 2020KY145), and has been registered in the Chinese Clinical Trial Registry (ChiCTR2300073809) on 21 Jul 2023.

Assessment of pelvic floor 4D ultrasound

Pelvic floor 4D ultrasound has been widely recommended for several years to assess pelvic floor morphology because of its noninvasiveness and objectivity [17]. All ultrasound assessments were performed by an experienced sonographer (Y.W.) at the Fujian Maternity and Child Health Hospital. The figures used for the assessments were stored on a computer and then checked by another sonographer (Y.Z.) to ensure the accuracy of the measurement results. Ultrasonic measurements were performed in three different positions of the pelvis (anterior pelvic tilt, posterior pelvic tilt, and neutral pelvic tilt) in the supine lithotomy position. The primary supine lithotomy position was considered a neutral pelvic tilt. During the positions of the anterior pelvic tilt and posterior pelvic tilt, a 5 cm pillow was placed under the third lumbar spine to tilt the pelvis anteriorly and under the tailbone to tilt the pelvis posteriorly. The participants were asked to lie down on pillows as relaxed as possible to eliminate the interference of synergistic muscle contraction (Figs. 1, 2 and 3). There was a 1-min rest among the three measurements, and the position was chosen randomly during the test in case of fatigue and practice effects.

Fig. 1
figure 1

Neutral pelvic tilt (provided by Y.W.)

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Fig. 2
figure 2

Anterior pelvic tilt (provided by Y.W.)

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Fig. 3
figure 3

Posterior pelvic tilt (provided by Y.W.)

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Transperineal ultrasound with a Mindray Reson8s 4D ultrasound system (Mindray Reson8s [11], Shenzhen, Guangdong, China) was used to evaluate the pelvic floor morphometry of the participants. The participants who underwent the test were placed in the supine lithotomy position, and a transducer (D8-2U Resona 8, Shenzhen, Guangdong, China) was placed on the perineum in a mid-sagittal plane, with a sweep angle of 85 degrees obtained at rest, during the Valsalva manoeuvres and PFM contraction. The participants were asked to perform the Valsalva manoeuvres and PFM contractions until they mastered the test correctly, and the following guiding words were used during the practice: “Please hold in as if you are experiencing an urge to urinate and have a bowel movement at the same time” and “Please inhale deeply and hold your breath, then tense your chest and abdominal muscles and push down as if you are defecating or giving birth”. At most, three Valsalva manoeuvres and PFM contractions were needed, with the most effective contraction being used for evaluation. The hiatal area was measured under three pelvic conditions, while the bladder neck position, cervical position, and rectal ampulla position were only measured at rest and during the Valsalva manoeuvre, in which the lower margin of the symphysis pubis was used as the reference line. Figure 4a-e show the measurement of the parameters used in the present study. Negative numbers indicated that the pelvic organs were below the lower margin of the pubic symphysis. POP on transperineal ultrasound was defined on the basis of previously published cutoffs of descent at ≥ 0 mm, ≥ 0 mm, ≥ 15 mm, and ≥ 0 mm below the symphysis pubis for cystocele, uterine prolapse, perineal overactivity, and rectocele, respectively, and hiatal ballooning was defined as a hiatal area ≥ 20 cm2 [18]. The following equations were utilizes: urethral rotation angle = urethral tilt angle (at rest) - urethral tilt angle (during the Valsalva manoeuvre); cervical descent = cervical position (at rest) - cervical position (during the Valsalva manoeuvre); bladder neck descent = bladder neck position (at rest) - bladder neck position (during the Valsalva manoeuvre); hiatal area increase = hiatal area (during the Valsalva manoeuvre) - hiatal area (at rest); and hiatal area decrease = hiatal area (at rest) - hiatal area (during contraction).

Fig. 4
figure 4

a Hiatal area at rest; b Hiatal area at contraction; c Hiatal area during Valsalva manoeuvre; d Parameters measured at rest. The main structures (yellow letters) identified on this plane are, from left to right, symphysis (SP), bladder (BL), urethra (U), cervix uteri (CX), vagina (V), anal canal (A), rectum (R), levator ani muscles (LAM). The gray letters are S (the reference line of symphysis), EU (the line of proximal urethra), UR (the line of posterior wall of bladder), V (the distance from reference line to the lowest point of bladder), C (the lowest point of cervix uteri), A (the lowest point of rectum). The measurements in the top right (white letters) are bladder neck-symphysis distance (BSD), retrovesical angle (RVA), urethral tilt angle (UTA), cervix uteri-symphysis (Cx-SP), ampullae recti-symphysis (RA-SP); e The parameters (white letters) measured during Valsalva manoeuvre are bladder neck-symphysis distance (BSD), retrovesical angle (RVA), bladder posterior wall-symphysis (BPW-SP), urethral tilt angle (UTA), cervix uteri-symphysis (Cx-SP), ampullae recti-symphysis (RA-SP), bladder neck descent (BND), urethral rotation angle (URA)

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Sample size calculation

A preliminary experiment with 41 participants was conducted. Among the ultrasonic parameters, bladder neck descent, cervical descent, rectal ampulla descent, hiatal area increase, and hiatal area decrease were the best indicators of changes in the pelvic floor in different pelvic positions. Thus, these parameters were chosen as references for the sample size calculation. G*Power 3.1 was used to calculate the required sample size for the present study. Sample sizes of 24, 52, 87, 73, and 49 participants were required to detect 95% power and a significance level of p =.05 according to the values of bladder neck descent (2.69 ± 0.78, 2.21 ± 0.88, and 3.23 ± 0.88, respectively), cervical descent (2.05 ± 1.16, 2.05 ± 1.16, and 2.90 ± 1.02, respectively), rectal ampulla descent (2.74 ± 0.76, 2.49 ± 0.84, and 3.02 ± 0.88, respectively), hiatal area increase (6.39 ± 3.72, 5.32 ± 3.30, and 7.86 ± 3.88, respectively), and hiatal area decrease (2.88 ± 1.58, 2.33 ± 0.99, and 3.63 ± 1.61, respectively) in the three pelvic positions.

Statistical analysis

All the statistical analyses were performed via SPSS software version 26.0. Counting data are expressed as n%, and measurement data are expressed as \( \bar x \pm s \) and quartiles according to the results of the normality test. The chi-square test was used to compare the differences in counting data. Moreover, one-way ANOVA and the Kruskal‒Wallis test were also used to assess the differences among the anterior pelvic tilt group, posterior pelvic tilt group, and neutral pelvic tilt group. For all tests, a two-tailed P value < 0.05 was considered statistically significant.

Results

A total of 189 subjects who met the inclusion and exclusion criteria were invited to participate in the present study, but 28 subjects did not meet the inclusion criteria, and 29 subjects were rejected (Fig. 5). Finally, 132 participants were included in this analysis. The baseline demographic features are summarized in Table 1.

Fig. 5
figure 5

Flow chart

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Table 1 The participants’ individual and obstetric characteristics
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The differences in the diagnoses of cystocele, uterine prolapse, perineal overactivity, and hiatal ballooning among the neutral pelvic tilt, anterior pelvic tilt, and posterior pelvic tilt groups were statistically significant (P <.001, P <.001, P <.001, P <.001, and P <.001, respectively) (Table 2).

Table 2 Diagnosis of pelvic organ prolapse in different pelvic position
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The differences among neutral pelvic tilt, anterior pelvic tilt, and posterior pelvic tilt in hiatal area during contraction, hiatal area at rest, hiatal area during the Valsalva manoeuvre, bladder neck descent, urethral rotation angle, cervical descent, rectal ampulla descent, hiatal area increase, and hiatal area decrease were statistically significant (P <.001, P <.001, P <.001, P <.001, P <.001, P <.001, P <.001, P <.001, and P <.001, respectively). The values of hiatal area at rest, hiatal area during the Valsalva manoeuvre, bladder neck descent, urethral rotation angle, cervical descent, rectal ampulla descent in neutral pelvic tilt were higher than that of anterior pelvic tilt (P =.019, P =.010, P <.001, P =.008, P =.001, and P =.024, respectively). In addition, the values of hiatal area during contraction, hiatal area at rest, hiatal area during the Valsalva manoeuvre, bladder neck descent, cervical descent, rectal ampulla descent, hiatal area increase, hiatal area decrease in neutral pelvic tilt were lower than that of posterior pelvic tilt (P <.001, P <.001, P <.001, P <.001, P <.001, P <.001, P <.001, and P <.001, respectively). Moreover, the values of hiatal area during contraction, hiatal area at rest, hiatal area during the Valsalva manoeuvre, bladder neck descent, urethral rotation angle, cervical descent, rectal ampulla descent, hiatal area increase, hiatal area decrease in anterior pelvic tilt were lower than that of posterior pelvic tilt (P <.001, P <.001, P <.001, P <.001, P <.001, P <.001, P <.001, P <.001, and P <.001, respectively). The differences in cervical position at rest, rectal ampulla position at rest, and bladder neck position during the Valsalva manoeuvre, cervical position during the Valsalva manoeuvre, and rectal ampulla position during the Valsalva manoeuvre among neutral pelvic tilt, anterior pelvic tilt, and posterior pelvic tilt were statistically significant (P <.001, P =.035, P <.001, P <.001, and P <.001, respectively). The values of bladder neck position during the Valsalva manoeuvre, cervical position during the Valsalva manoeuvre, and rectal ampulla position during the Valsalva manoeuvre in neutral pelvic tilt were lower than that of anterior pelvic tilt (P =.001, P <.001, and P <.001, respectively). Moreover, the values of cervical position at rest, bladder neck position during the Valsalva manoeuvre, cervical position during the Valsalva manoeuvre, and rectal ampulla position during the Valsalva manoeuvre in neutral pelvic tilt were higher than that of posterior pelvic tilt (P =.003, P <.001, P <.001 and P <.001, respectively). The values of cervical position at rest, rectal ampulla position at rest, and bladder neck position during the Valsalva manoeuvre, cervical position during the Valsalva manoeuvre, and rectal ampulla position during the Valsalva manoeuvre in anterior pelvic tilt were higher than that of posterior pelvic tilt (P <.001, P =.041, P <.001, P <.001, and P <.001, respectively) (Table 3).

Table 3 Differences of pelvic ultrasonic parameters in three pelvic positions
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Discussion

Overall, the present results revealed that the pelvic positions do have effects on the performing of PFM contraction and the Valsalva manoeuvre. Compared with the other positions, the posterior pelvic tilt shows greater reduction in the hiatal area after PFM contraction. During the Valsalva manoeuvre, the posterior pelvic tilt is a position that not only shows the greatest increase in the hiatal area but also the bladder neck, cervical neck, and rectal ampulla are pushed to the lowest position.

As a POP staging system, pelvic organ prolapse quantization (POP-Q) is the most commonly used method in clinical assessments despite the disadvantages of subjectivity and inadequate diagnosis of muscle defects [19]. To complement clinical assessment, X-ray, computed tomography (CT), ultrasound, and magnetic resonance imaging (MRI) are common auxiliary examinations developed in recent years [20,21,22]. Although MRI is able to rapidly and clearly image the entire pelvic floor, ultrasound is more acceptable because it does not require radiation and it is cost-effective [23, 24]. The present results revealed that PFM strength is greater in the posterior pelvic tilt position than in the other positions. Although the greatest hiatal area is in the posterior pelvic tilt at PFM contraction, the decrease in the hiatal area in the posterior pelvic tilt is greater than that in any other position. Ptaszkowski et al. reported that the posterior pelvic tilt position results in increased resting and functional bioelectric activity of the PFM [25]. Bø, K et al. reported that hip adduction, gluteal muscle contraction, and abdominal muscle contraction result in synergistic contraction of the PFM [26]. Similarly, Soljanik, Irina et al. revealed that 97.2% of subjects exhibit synchronous movements of the PFM and gluteal muscle [27]. Ptaszkowski et al. reported greater rectus abdominis, gluteus maximus, and adductor magnus bioelectrical activity in posterior pelvic tilt; however, they indicated that there is no relationship between the activity of those synergist muscles and PFM, suggesting that synergist muscles are unlikely to be the cause of greater PFM contraction ability [15]. In the present study, participants were positioned such that their pelvis was anteriorly or posteriorly tilted so that their muscles relaxed as much as possible, making the synergist muscles less likely to participate in PFM contraction. Although the potential mechanism is still unclear, posterior pelvic tilt should be implemented in pelvic floor rehabilitation to improve the effect on the pelvic floor.

The present results revealed that at rest, a greater position of the pelvic organ is in the anterior pelvic tilt. Mattox et al. and Zacharin reported that a normative lumbosacral curve may protect the pelvic floor from direct intra-abdominal forces [28, 29]. The pressure from intra-abdominal forces is greater in the hypo-lordotic posture and pelvic posterior tilt, and the present finding that the hiatal area (at rest) is the smallest in the anterior pelvic tilt also suggests that the pelvic floor bears less pressure in that position [30, 31]. In contrast to the neutral pelvic tilt and posterior pelvic tilt, the reference line—the lower margin of the pubic symphysis—moves downwards in the anterior pelvic tilt, and the pelvic floor organs are positioned relatively upwards. In addition, Ruth R et al. reported that the anterior pelvic tilt results in greater PFM resting activity and thus maintains the area of the levator hiatus [16]. These findings may support the present results, demonstrated that the hiatal area is smallest in the anterior pelvic tilt group.

During the Valsalva manoeuvre, all the pelvic organs are pushed to the lowest position and have the greatest descent in the posterior pelvic tilt. Moreover, the hiatal area expands more in the posterior pelvic tilt position than in the other positions because of greater pressure from intra-abdominal forces. In obstetrics, the squatting position has been shown to shorten the labour time because it is similar to the position of defecation [32, 33]. The pelvis is forced to tilt posteriorly in that position, and both labour and defecation resemble the Valsalva manoeuvre. In addition, the physiological characteristic of the pelvic inlet determines that it has a forward and downward angle in the neutral pelvic tilt direction (Fig. 6). The pelvic inlet is oriented more vertically in the posterior pelvic tilt position than in other positions, which leads to direct intra-abdominal forces to the pelvic floor. Similar to the present study, JOHN K. et al. reported greater prolapse in the posterior pelvic tilt [34]. In the present study, the participants performed PFM contraction and the Valsalva manoeuvre well in the neutral position and posterior position. Owing to the universality of anterior pelvic tilt in the postpartum period, it is important to induce subjects to relax their waist during physical examination to make the lumbosacral joints as close to the bed as possible to obtain more accurate results [35].

Fig. 6
figure 6

The tilt of the pelvic inlet

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The present study had several limitations. The present study included only postpartum vaginal participants, indicating that the results cannot be generalized to all age groups. In addition, the present study did not assess POP-related symptoms, which are important references for ultrasonic measurement results. Although studies on reproducibility and repeatability in the neutral position have been reported, no study has investigated the position of the anterior pelvic tilt and posterior pelvic tilt, which may undermine the credibility of the present study. Finally, the present study did not assess PFM displacement, PFM muscle thickness, or POP parameters during PFM contraction, which are important in the evaluation of POP.

Conclusion

During PFM contraction, the posterior pelvic tilt results in the greatest reduction in the hiatal area compared with other positions The greatest increases in the hiatal area, bladder neck descent, cervical neck descent, and rectal ampulla descent were observed in the posterior pelvic tilt position during the Valsalva manoeuvre. Further studies are recommended to explore the mechanism underlying the better performance of PFM contraction and the Valsalva manoeuvre in the posterior pelvic tilt.

Data availability

The datasets analysed during the current study are not publicly available but are available from the corresponding author on reasonable request.

References

  1. Toozs-Hobson P, Freeman R, Barber M, Maher C, Haylen B, Athanasiou S, et al. An international urogynecological association (IUGA)/International continence society (ICS) joint report on the terminology for reporting outcomes of surgical procedures for pelvic organ prolapse. Int Urogynecol J. 2012;23(5):527–35.

    Article  PubMed  Google Scholar 

  2. Schulten SFM, Claas-Quax MJ, Weemhoff M, van Eijndhoven HW, van Leijsen SA, Vergeldt TF, et al. Risk factors for primary pelvic organ prolapse and prolapse recurrence: an updated systematic review and meta-analysis. Am J Obstet Gynecol. 2022;227(2):192–208.

    Article  PubMed  Google Scholar 

  3. Hadizadeh-Talasaz Z, Khadivzadeh T, Mohajeri T, Sadeghi M. Worldwide Prevalence of Pelvic Organ Prolapse: A Systematic Review and Meta-Analysis. Iran j public health. 2024;null(null):null.

  4. Fritel X, Varnoux N, Zins M, Breart G, Ringa V. Symptomatic pelvic organ prolapse at midlife, quality of life, and risk factors. Obstet Gynecol. 2009;113(3):609–16.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Sanses TV, Schiltz NK, Couri BM, Mahajan ST, Richter HE, Warner DF, et al. Functional status in older women diagnosed with pelvic organ prolapse. Am J Obstet Gynecol. 2016;214(5):e6131–7.

    Article  Google Scholar 

  6. Robinson D, Prodigalidad LT, Chan S, Serati M, Lozo S, Lowder J, et al. International urogynaecology consultation chap. 1 committee 4: patients’ perception of disease burden of pelvic organ prolapse. Int Urogynecol J. 2022;33(2):189–210.

    Article  PubMed  Google Scholar 

  7. Dietz H. Pelvic floor ultrasound. Curr Surg Rep. 2013;1(3):167–81.

    Article  Google Scholar 

  8. Moser H, Luginbuehl H, Baeyens JP, Radlinger L. Reliability and validity of pelvic floor muscle displacement measurements during voluntary contractions. Int Urogynecol J. 2019;30(12):2093–100.

    Article  PubMed  Google Scholar 

  9. Nyhus M, Oversand SH, Salvesen Ø, Salvesen K, Mathew S, Volløyhaug I. Ultrasound assessment of pelvic floor muscle contraction: reliability and development of an ultrasound-based contraction scale. Ultrasound Obst Gyn. 2020;55(1):125–31.

    Article  CAS  Google Scholar 

  10. Dietz HP, Haylen BT, Broome J. Ultrasound in the quantification of female pelvic organ prolapse. Ultrasound Obst Gyn. 2001;18(5):511–4.

    Article  CAS  Google Scholar 

  11. Rodrigues MP, Paiva LL, Mallmann S, Bessel T, Ramos JGL. Can the inability to contract the pelvic floor muscles influence the severity of urinary incontinence symptoms in females? Int Urogynecol J. 2022;33(5):1193–7.

    Article  PubMed  Google Scholar 

  12. Slieker-ten Hove MC, Pool-Goudzwaard AL, Eijkemans MJ, Steegers-Theunissen RP, Burger CW, Vierhout ME. Pelvic floor muscle function in a general female population in relation with age and parity and the relation between voluntary and involuntary contractions of the pelvic floor musculature. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20(12):1497–504.

    Article  PubMed  Google Scholar 

  13. Barber MD, Lambers A, Visco AG, Bump RC. Effect of patient position on clinical evaluation of pelvic organ prolapse. Obstet Gynecol. 2000;96(1):18–22.

    CAS  PubMed  Google Scholar 

  14. Braverman M, Kamisan Atan I, Turel F, Friedman T, Dietz HP. Does patient posture affect the ultrasound evaluation of pelvic organ prolapse?? J Ultras Med. 2019;38(1):233–8.

    Article  Google Scholar 

  15. Ptaszkowski K, Zdrojowy R, Ptaszkowska L, Bartnicki J, Taradaj J, Paprocka-Borowicz M. Electromyographic evaluation of synergist muscles of the pelvic floor muscle depending on the pelvis setting in menopausal women: A prospective observational study. Gait Posture. 2019;71(null):170–6.

    Article  PubMed  Google Scholar 

  16. Sapsford RR, Richardson CA, Maher CF, Hodges PW. Pelvic floor muscle activity in different sitting postures in continent and incontinent women. Arch Phys Med Rehab. 2008;89(9):1741–7.

    Article  Google Scholar 

  17. Van Geelen H, Ostergard D, Sand P. A review of the impact of pregnancy and childbirth on pelvic floor function as assessed by objective measurement techniques. Int Urogynecol J. 2018;29(3):327–38.

    Article  PubMed  Google Scholar 

  18. Zhang X. Practical ultrasound diagnosis of pelvic floor. People’s Med Publishing House. 2019;48:72–6. 81.

    Google Scholar 

  19. Boyd SS, O’Sullivan D, Tulikangas P. Use of the pelvic organ quantification system (POP-Q) in published articles of peer-reviewed journals. Int Urogynecol J. 2017;28(11):1719–23.

    Article  PubMed  Google Scholar 

  20. Derpapas A, Digesu GA, Fernando R, Khullar V. Imaging in urogynaecology. Int Urogynecol J. 2011;22(11):1345–56.

    Article  PubMed  Google Scholar 

  21. Beyersdorff D, Schiemann T, Taupitz M, Kooijman H, Hamm B, Nicolas V. Sectional depiction of the pelvic floor by CT, MR imaging and sheet plastination: computer-aided correlation and 3D model. Eur Radiol. 2001;11(4):659–64.

    Article  CAS  PubMed  Google Scholar 

  22. Palma P, Riccetto C, Fraga R, Miyaoka R, Prando A. Dynamic evaluation of pelvic floor reconstructive surgery using radiopaque meshes and three-dimensional helical CT. Int Braz J Urol. 2010;36(2):209–14. discussion 15– 7.

    Article  PubMed  Google Scholar 

  23. Ahmad AN, Hainsworth A, Williams AB, Schizas AM. A review of functional pelvic floor imaging modalities and their effectiveness. Clin Imag. 2015;39(4):559–65.

    Article  Google Scholar 

  24. Khatri G, Bhosale PR, Robbins JB, Akin EA, Ascher SM, Brook OR, et al. ACR appropriateness Criteria® pelvic floor dysfunction in females. J Am Coll Radiol. 2022;19(5s):S137–55.

    Article  PubMed  Google Scholar 

  25. Ptaszkowski K, Zdrojowy R, Slupska L, Bartnicki J, Dembowski J, Halski T, et al. Assessment of bioelectrical activity of pelvic floor muscles depending on the orientation of the pelvis in menopausal women with symptoms of stress urinary incontinence: continued observational study. Eur J Phys Rehab Med. 2017;53(4):564–74.

    Google Scholar 

  26. Bø K, Stien R. Needle EMG registration of striated urethral wall and pelvic floor muscle activity patterns during cough, Valsalva, abdominal, hip adductor, and gluteal muscle contractions in nulliparous healthy females. Neurourol Urodynam. 1994;13(1):35–41.

    Article  Google Scholar 

  27. Soljanik I, Janssen U, May F, Fritsch H, Stief CG, Weissenbacher ER, et al. Functional interactions between the fossa ischioanalis, levator Ani and gluteus Maximus muscles of the female pelvic floor: a prospective study in nulliparous women. Arch Gynecol Obstet. 2012;286(4):931–8.

    Article  PubMed  Google Scholar 

  28. Mattox TF, Lucente V, McIntyre P, Miklos JR, Tomezsko J. Abnormal spinal curvature and its relationship to pelvic organ prolapse. Am J Obstet Gynecol. 2000;183(6):1381–4. discussion 4.

    Article  CAS  PubMed  Google Scholar 

  29. R.F Z. Pelvic floor anatomy and the surgery of pulsion enterocoele. New York: Springer; 1985.

    Google Scholar 

  30. Capson AC, Nashed J, McLean L. The role of lumbopelvic posture in pelvic floor muscle activation in continent women. J Electromyogr Kines. 2011;21(1):166–77.

    Article  Google Scholar 

  31. Young K, Mou T, Geynisman-Tan J, Tavathia M, Collins S, Mueller M, et al. Truth or Myth: Intra-abdominal pressure increases in the lithotomy position. J Minim Invas Gyn. 2021;28(1):26–9.

    Article  Google Scholar 

  32. Golay J, Vedam S, Sorger L. The squatting position for the second stage of labor: effects on labor and on maternal and fetal well-being. Birth-iss Perinat C. 1993;20(2):73–8.

    Article  CAS  Google Scholar 

  33. Walker C, Rodríguez T, Herranz A, Espinosa JA, Sánchez E, Espuña-Pons M. Alternative model of birth to reduce the risk of assisted vaginal delivery and perineal trauma. Int Urogynecol J. 2012;23(9):1249–56.

    Article  PubMed  Google Scholar 

  34. Nguyen JK, Lind LR, Choe JY, McKindsey F, Sinow R, Bhatia NN. Lumbosacral spine and pelvic Inlet changes associated with pelvic organ prolapse. Obstet Gynecol. 2000;95(3):332–6.

    CAS  PubMed  Google Scholar 

  35. Morino S, Ishihara M, Umezaki F, Hatanaka H, Yamashita M, Aoyama T. Pelvic alignment changes during the perinatal period. PLoS ONE. 2019;14(10):e0223776.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

Not applicable.

Funding

This study was founded by 2020 Science and Technology Innovation Start-up Fund of Fujian Maternity and Child Health Hospital (No.YCXM 20–44).

Author information

Author notes

  1. Yu Wang and Yan Zhuo contributed equally to this work.

Authors and Affiliations

  1. Department of ultrasound, Fujian Maternity and Child Health Hospital, Fuzhou, 350000, Fujian, People’s Republic of China

    Yu Wang, Yan Zhuo, Min Liu & Zongjie Weng

  2. Fujian Key Laboratory of Women and Children’s Critical Diseases Research, Fujian Maternity and Child Health Hospital (Fujian Women and Children’s Hospital), Fuzhou, 350000, Fujian, People’s Republic of China

    Yu Wang

  3. Department of women’s health care, Fujian Maternity and Child Health Hospital, Fuzhou, 350000, Fujian, People’s Republic of China

    Jianqi Fang

Authors
  1. Yu Wang
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  2. Yan Zhuo
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  3. Min Liu
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  4. Jianqi Fang
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  5. Zongjie Weng
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Contributions

Y.W. M.L. and Y.Z. collected the data and prepared all the figures; Y.W. wrote the main manuscript text and analysed the data; J.F. edited the manuscript; Z.W. design the study and supervised it. All authors reviewed the manuscript.

Corresponding authors

Correspondence to Jianqi Fang or Zongjie Weng.

Ethics declarations

Ethics approval and consent to participate

The study was approved by the Ethics Committee of Fujian Maternity and Child Health Hospital (No. 2020KY145) and was conducted in accordance with Chinese law and the Guidelines of the National Human Biomedical Research Policies. All participants were asked to sign an consent form before they were included in this study was obtained from the patients.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

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Wang, Y., Zhuo, Y., Liu, M. et al. Effect of pelvic position on ultrasonic measurement parameters of pelvic floor in postpartum women. BMC Women's Health 25, 184 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12905-025-03708-0

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  • DOI: https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12905-025-03708-0

Keywords

BMC Women's Health

ISSN: 1472-6874

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