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To use static and dynamic magnetic resonance imaging MRI to compare dimensions of the bony pelvis and soft tissue structures in a sample of African-American and white women.

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This study used data from participants in the Childbirth and Pelvic Symptoms Imaging Study, a cohort study of primiparous women with an obstetric anal Black vagina exam tear, 94 who delivered vaginally without a recognized anal sphincter tear and 36 who underwent by cesarean delivery without labor.

At 6—12 months postpartum, rapid acquisition T2-weighted pelvic MRIs were obtained. Bony and soft tissue dimensions Black vagina exam measured and compared between white and African-American participants using analysis of variance, while controlling for delivery type and age.

The pelvic inlet was wider among white women than 56 African-American women The outlet was also wider mean intertuberous diameter There were no significant differences between racial Black vagina exam in Black vagina exam diameter, angle of the subpubic arch, anteroposterior conjugate, levator thickness, or levator hiatus. In addition, among women who delivered vaginally without a sphincter tear, African-American women had more Black vagina exam floor mobility than white women.

This difference was not observed among women who had sustained an obstetric sphincter tear. White women have a wider pelvic inlet, wider outlet, and shallower anteroposterior outlet than African-American women.

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In Black vagina exam, after vaginal delivery, white women demonstrate less pelvic floor mobility. These differences may contribute to observed racial differences in obstetric outcomes and to the development of pelvic floor disorders.

Magnetic resonance imaging MRI Black vagina exam been in use in the characterization of the female pelvis since the mid s.

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As a result, MRI has become an important adjunct to physical examination and fluoroscopy for the evaluation of pelvic anatomy. Before MRI, conventional radiography suggested that the architecture of the bony pelvis differs between white and African-American women. More recently, differences in the dimensions of the posterior pelvis 3 have been observed Black vagina exam MRI. The potential clinical implications of racial differences in anatomy include a possible association with variations in obstetric outcomes 4 — 6 and in the Black vagina exam of pelvic floor disorders.

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The objective of this study was to compare MRI dimensions of the bony pelvis in African-American and white women. In addition, the study evaluated MRI measurements based upon soft tissues within the pelvis, including static images at rest and dynamic measurements at rest and during Valsalva. Our goal is to confirm earlier data 12 suggesting racial differences in pelvic anatomy between African-American and white women.

The CAPS study was a prospective cohort study of primiparous women designed to study the relationship between vaginal delivery with a sphincter laceration and subsequent incontinence.

Women in this study were recruited from the participants in CAPS. Methods of the CAPS study have been Black vagina exam in detail 13 and are briefly summarized here.

Enrollment into this study was conducted from September to February Three cohorts of primiparous women were recruited while the women were hospitalized after a singleton delivery. Two comparison groups were recruited: We attempted to include all women who delivered with a sphincter laceration.

For each woman with an anal sphincter tear recruited for this study, we recruited the next consecutive woman who delivered vaginally without a clinically recognized sphincter tear.

We attempted to include all women who delivered by cesarean without labor. This research protocol was approved at the institutional review boards at all clinical sites and the central data coordinating center. All women provided Black vagina exam consent for participation. Data for this investigation were obtained 6—12 months after delivery. Weight and height were measured, and body mass index was calculated for each subject.

Subjects were allowed to report more than one race but were asked to select a primary racial category if more than one race was indicated. The MRI protocol was standardized at a 1-day training session, led by the expert consulting radiologist at the central site before study initiation.

After centralized training, images were acquired using a 1. Ultrasound gel 60 mL was placed in the rectum. After localizer images, we obtained sagittal ultra-fast T2-weighted images rest and strainBlack vagina exam transverse and coronal T2-weighted images rest.

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For straining images, participants were coached to strain without elevating the lumbosacral spine or thighs. Each dynamic image required 2 seconds for acquisition.

On sagittal images, the pubococcygeal line was used to represent the normal location of the pelvic floor. Rest and maximal strain midsagittal images were obtained to Black vagina exam the descent of the bladder neck and anorectal junction, anteroposterior length of the hiatus, and angle of the Black vagina exam plate with the pubococcygeal line.

The angle of the posterior rectal wall relative to the pubococcygeal line was measured at rest and during Valsalva.

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The H line, the distance from the inferior posterior aspect of the symphysis to the posterior rectal wall, was calculated. This represents the anteroposterior width of the genital hiatus. The distance from the posterior end of the H line, measured perpendicular to Black vagina exam pubococcygeal line, represented the Black vagina exam line. On the midsagittal image, we also obtained the following bony measures Representative T2-weighted midsagittal magnetic resonance images are shown, both at rest A and with maximal strain B.

The pubococcygeal line PCLconnecting the inferior border of the symphysis and the last vertical joint of the coccyx, represents the location of the normal pelvic floor. The H line is the distance from the inferior symphysis to the posterior rectal wall, at the level of the anorectal junction.

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The M Black vagina exam is the distance perpendicular from the pubococcygeal line to the same point on the posterior rectal wall. Axial measurements of levator muscle thickness were obtained at the level of the constrictor urethrae muscle.

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The width of the genital hiatus was obtained at the cranial-most image that included the symphysis. Bony measurements obtained on axial images included the angle of the pubic arch in degrees, with the symphysis as the apexthe intertuberous diameter measured from the posterior and medial cortex of the ischial tuberositiesBlack vagina exam the interspinous diameter measured from the posterior ischial spines. Using the coronal image that included the femoral heads and fovea, we measured Black vagina exam transverse inlet from the inner aspect of the ischial cortex at the level of the fovea on each side.

The transverse diameter of the pelvic inlet was measured at the level of the fovea.

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On oblique coronal images obtained in the plane of the sacrum, the maximum transverse inlet diameter was measured again. Standardized images were obtained at six clinical sites. Images were reviewed by the site radiologist and a central radiologist.

Image interpretation was standardized through a full day of in-person training for research radiologists. Our prior research personal communication: Richter, Linda Brubaker, Caryl G.

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Salomon, Wen Ye, et al. Reproducibility of Dynamic MRI pelvic measures: Submitted to Radiologysuggested high variability among readers of pelvic MRI measurements, particularly with respect to soft-tissue parameters. As a result, this research used the measures obtained by the central reader in all cases. The mean and standard deviations for each dimension were calculated for African-American and white women.

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There were too few women of other races for meaningful comparisons. The initial analysis compared the two racial groups, adjusting only for cohort. When adjustment for age significantly changed the result or age was significant in either the African-American or white populationwe performed a second analysis restricted to the subpopulation of women under the age of 30, adjusting for cohort; the limit of age 30 was chosen because there were too few African-Americans above the limit to provide a Black vagina exam estimate of the age effect.

Otherwise, we report results from the initial analyses. For all measures, the interaction effect between cohort and race was also examined using only subjects Black vagina exam the age of 30 in the two larger cohorts; there were insufficient observations in the cesarean delivery cohort for inclusion in this analysis. Normal support was defined as the bladder neck above the pubococcygeal line with strain.

In cases of normal support, descent of Black vagina exam bladder neck was not quantified. If the bladder neck descended below the pubococcygeal line, the descent was measured in centimeters. A similar strategy was used for the angle of levator plate with rest and with straining. Again, descent was measured only if the levator plate was below the pubococcygeal line.

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When the angle of the levator plate extended below the pubococcygeal Black vagina exam, the angle was measured in degrees. When no significant difference was detected, analysis of variance was Black vagina exam to test for a difference in the severity of descentbetween races eg, among women with abnormal support. In all analyses, we adjusted for cohort effect.

Black vagina exam did not adjust for height, body mass index, or site because they had no effect on the inferences. These 12 women were excluded because there were too few for meaningful comparisons. The demographic and obstetric characteristics Black vagina exam the two groups are shown in Table 1.

Magnetic resonance imaging pelvimetry measures are shown in Table 2. Among white women, the pelvic outlet was significantly wider mean intertuberous diameter The length of the sacrum was longer for white women The two groups did not differ with respect to the angle of the subpubic arch, the anteroposterior conjugate or the depth of sacral hollow. Among women who delivered vaginally without a sphincter tear, the anteroposterior outlet was significantly shallower among white women than African-American women mean anteroposterior outlet Although the relationship between race and interspinous diameter varied significantly by cohort, there were no significant racial differences in interspinous diameter in either cohort.

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All dimensions are in centimeters unless otherwise noted. Magnetic resonance imaging soft tissue results for African-American Black vagina exam white women are shown in Table 3. The levator hiatus width was similar between African-American and white women.

For five soft-tissue measures Table 3the differences between race varied by delivery cohort.

Among women who delivered vaginally without a sphincter tear, the H line with straining was shorter among white than African-American women 4. Black vagina exam, in the vaginal delivery cohort, the M line with straining was shorter among white women 2.

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No significant differences in these measures were observed between races in the cohort of women with an anal Black vagina exam tear. Magnetic resonance imaging assessment of bladder neck support Table 4 was similar between racial groups. Also, there was no racial difference in the angle of the levator plate. For those with abnormal descent, the mean descent was not significantly different between white and African-American women.

You may Black vagina exam worried about your first pelvic exam. It's very normal to be uneasy about something when you don't know what to expect.


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