Urethral Hypermobility and Levator Ani Ballooning in Primigravida: A Preliminary Report

Gita Nurul Hidayah (dr Cipto Mangunkusumo Hospital-Faculty of Medicine University of Indonesia)
Ayyada Khairunnisa (Jakarta Urogynecology (JUN) Center, YPK Mandiri Hospital, Jakarta, Indonesia)
Muhammad Syah Nadir Chan (Jakarta Urogynecology (JUN) Center, YPK Mandiri Hospital, Jakarta, Indonesia)
Fernandi Moegni
Firda Hanan Bahjah
Alfa Putri Meutia (Urogynecology, Reconstructive Pelvic and Aesthetic Surgery Division, Department of Obstetrics and Gynecology, dr. Cipto Mangunkusumo Hospital Jakarta-Faculty of Medicine, University of Indonesia, Depok, Indonesia)
Budi Iman Santoso

eJournal Kedokteran Indonesia
Vol. 14 No. 2 (2026): Vol 14, No. 2 - Agustus 2026

Pelvic floor dysfunction (PFD) has been develop even before first delivery, with clinical manifestations frequently include pelvic organ prolapse (POP) and urinary incontinence (UI). This study aimed to characterize ultrasound-defined urethral hypermobility in strictly primigravid women during late pregnancy. This cross-sectional study included primigravid women (18–35 years) at  36 weeks gestation undergoing transperineal ultrasound. Urethral hypermobility was defined by alternating threshold, bladder neck descent (BND) >20.8 mm, or retrovesical angle (RVA) >141.5°, or urethral rotational angle (URA) >19.43°. Among 32 participants, urethral hypermobility was identified in 15 (46.9%) and levator ani ballooning in 2 (6.3%). RVA during Valsalva was potentially significant differ in women with hypermobility than in those without (138.3 ± 26.3° vs. 92.5 ± 33.2°, p<0.001). No significant differences were found in URA or BND.  Dynamic urethral support changes are identifiable before the first delivery, with the most interesting finding was RVA during Valsalva potentially significant between groups.