The Role of Platelet Rich Plasma Towards the Repair of Pelvic Floor Muscle Damage in Primipara

This study aims to see if platelet rich plasma (PRP) have beneficial effect on the repair of pelvic floor muscle damage in primipara. Therefore, this double blinded randomized clinical trial compares the pelvic floor muscle repair in primipara following labor between the interventional group who received intramuscular PRP injection in levator ani muscle and the control group, as assessed by ultrasonography, perineometry, and biomarker assessments.

This study aims to see if platelet rich plasma (PRP) has beneficial effect on the repair of pelvic floor muscle damage in primipara. Therefore, this double blinded randomized clinical trial compares the pelvic floor muscle repair in primipara following labor between the interventional group who received intramuscular PRP injection in levator ani muscle and the control group, as assessed by ultrasonography, perineometry, and biomarker assessments. The ultrasonography outcome measures include lower hiatal area during contraction and during valsava. Menawhile, the biomarker assessments include Creatine Kinae, MyoD, and IGF-1. The assessments are performed at multiple time points, which are before labor, 24-48 hours post labor, 7 days post labor, 40 days post labor and 3 months post labor.

Platelet rich plasma injected intramuscularly in pelvic floor muscle immediately following labor and before perineoraphy, simultaneously with the injection of local anesthesia

Platelet rich plasma is produced by obtaining patient's whole blood and processed by centrifugation and activation by CaCl2.

Change from baseline (third trimester) lower hiatal area during contraction measured using pelvic floor USG at 7 days post partum

Change from baseline (third trimester) lower hiatal area during contraction measured using pelvic floor USG at 40 days post partum

Change from baseline (third trimester) lower hiatal area during contraction measured using pelvic floor USG at 3 months post partum

Change from baseline (third trimester) lower hiatal area measured using pelvic floor USG during valsava at 7 days post partum

Change from baseline (third trimester) lower hiatal area during valsava measured using pelvic floor USG at 40 days post partum

Change from baseline (third trimester) lower hiatal area during valsava measured using pelvic floor USG at 3 months post partum

Inclusion Criteria: primigravida, in third trimester pregnancy plan to do vaginal birth consent to participate in this study Exclusion Criteria: history of pelvic floor disorder before pregnancy history of pelvic surgery avulsion of levator ani muscle (seen in USG) unstable hemodynamic trombocytopenia (< 150,000) anemia (Hb< 10) sepsis infection on perineum corticosteroid intake within last 2 weeks smoking hematopoetic or bone cancer delivery by c-section no perineoraphy after birth