Skip to main content

Advertisement

Log in

Value of transperineal ultrasound on the observation of paravaginal support

  • General Gynecology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Objective

To explore the feasibility of three-dimensional (3D) transperineal ultrasound on the observation of paravaginal support in nulliparous and postpartum women.

Methods

Volume datasets were acquired in 50 nulliparous and 100 postpartum women using 3D transperineal ultrasound. Paravaginal supports were observed by studying the vaginal cross-sectional morphology. The extent of paravaginal support in specific level were evaluated by counting out at a 2 mm interval in tomographic ultrasound imaging mode in all subjects. The Mann–Whitney U test were applied to establish comparisons between the two groups.

Results

Three representative manifestations of vaginal cross-sectional morphology corresponding to different paravaginal support were presented from the dorsal side to the caudal side, both in nulliparous women and postpartum women. The extent of paravaginal support in middle vagina was 11 slices (range 9–12) in nulliparous women and 7 slices (range 4–10) in postpartum women (P < 0.05).

Conclusion

This pilot study confirmed that it was feasible to indirectly study paravaginal support by observing the vaginal cross-sectional morphology using 3D transperineal ultrasound.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, Monga A, Petri E, Rizk DE, Sand PK, Schaer GN (2010) An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. International Urogynecological Association; International Continence Society. Neurourol Urodyn 29(1):4–20

    PubMed  Google Scholar 

  2. Papa Petros P, Ulmsten U (1990) An integral theory of female urinary incontinence. Experimental and clinical considerations. Acta Obstet Gynecol Scand 153:7–31

    Article  Google Scholar 

  3. Petros PEP, Woodman PJ (2008) The integral theory of continence. Int Urogynecol J Pelvic Floor Dysfunct 19:35–40

    Article  PubMed  Google Scholar 

  4. DeLancey JO (1992) Anatomic aspects of vaginal eversion after hysterectomy. Am J Obstet Gynecol 166:1717–1724

    Article  CAS  PubMed  Google Scholar 

  5. DeLancey J (1994) Structural support of the urethra as it relates to stress urinary incontinence: the hammock hypothesis. Am J Obstet Gynecol 170:1713–1720

    Article  CAS  PubMed  Google Scholar 

  6. van Delft K, Sultan AH, Thakar R, Schwertner-Tiepelmann N, Kluivers K (2014) The relationship between postpartum levator ani muscle avulsion and signs and symptoms of pelvic floor dysfunction. BJOG 121(9):1164–1171

    Article  PubMed  Google Scholar 

  7. Dietz HP, Pattillo Garnham A, Rojas Guzmán (2017) Is it necessary to diagnose levator avulsion on pelvic floor muscle contraction? Ultrasound Obstet Gynecol 49(2):252–256

    Article  CAS  PubMed  Google Scholar 

  8. Ying T, Li Q, Xu L, Liu F, Hu B (2012) Three-dimensional ultrasound appearance of pelvic floor in nulliparous women and pelvic organ prolapse women. Int J Med Sci 9(10):894–900

    Article  PubMed  PubMed Central  Google Scholar 

  9. Dietz HP, Shek C, De Leon J, Steensma AB (2008) Ballooning of the levator hiatus. Ultrasound Obstet Gynecol 31(6):676–680

    Article  CAS  PubMed  Google Scholar 

  10. Dietz HP, Franco AV, Shek KL, Kirby A (2012) Avulsion injury and levator hiatal ballooning: two independent risk factors for prolapse? An observational study. Acta Obstet Gynecol Scand 91(2):211–214

    Article  PubMed  Google Scholar 

  11. Rostaminia G, White D, Hegde A, Quiroz LH, Davila GW, Shobeiri SA (2013) Levator ani deficiency and pelvic organ prolapse severity. Obstet Gynecol 121(5):1017–1024

    Article  PubMed  Google Scholar 

  12. Dietz HP, Severino M, Kamisan Atan I, Shek KL, Rojas Guzman (2016) Warping of the levator hiatus: how significant is it? Ultrasound Obstet Gynecol 48(2):239–242

    Article  CAS  PubMed  Google Scholar 

  13. Dietz HP, Shek KL (2009) Tomographic ultrasound imaging of the pelvic floor: which levels matter most? Ultrasound Obstet Gynecol 33(6):698–703

    Article  CAS  PubMed  Google Scholar 

  14. Yan Y, Dou C, Wang X, Xi Y, Hu B, Ma L, Ying T (2017) Combination of tomographic ultrasound imaging and three-dimensional magnetic resonance imaging-based model to diagnose postpartum levator avulsion. Sci Rep 7(1):11235

    Article  PubMed  PubMed Central  Google Scholar 

  15. Dumoulin C, Peng Q, Stodkilde-Jorgensen H, Shishido K, Constantinou C (2007) Changes in levator ani anatomical configuration following physiotherapy in women with stress urinary incontinence. J Urol 178(3 Pt 1):970–977

    Article  CAS  PubMed  Google Scholar 

  16. Khatri G, Carmel ME, Bailey AA, Foreman MR, Brewington CC, Zimmern PE, Pedrosa I (2016) Postoperative imaging after surgical repair for pelvic floor dysfunction. Radiographics 36(4):1233–1256

    Article  PubMed  Google Scholar 

  17. Betschart C, Kim J, Miller JM, Ashton-Miller JA, DeLancey JO (2014) Comparison of muscle fiber directions between different levator ani muscle subdivisions: in vivo MRI measurements in women. Int Urogynecol J 25(9):1263–1268

    Article  PubMed  PubMed Central  Google Scholar 

  18. Schofield MLA, Higgs P, Hawnaur JM (2005) MRI findings following laparoscopic sacrocolpopexy. Clin Radiol 60(3):333–339

    Article  CAS  PubMed  Google Scholar 

  19. Tunn R, Delancey JO, Howard D, Ashton-Miller JA, Quint LE (2003) Anatomic variations in the levator ani muscle, endopelvic fascia, and urethra in nulliparas evaluated by magnetic resonance imaging. Am J Obstet Gynecol 188(1):116–121

    Article  PubMed  Google Scholar 

  20. van Delft K, Thakar R, Sultan AH, Kluivers KB (2015) Does the prevalence of levator ani muscle avulsion differ when assessed using tomographic ultrasound imaging at rest vs on maximum pelvic floor muscle contraction? Ultrasound Obstet Gynecol 46(1):99–103

    Article  PubMed  Google Scholar 

  21. Macura KJ (2006) Magnetic resonance imaging of pelvic floor defects in women. Top Magn Reson Imaging 17(6):417–426

    Article  PubMed  Google Scholar 

  22. Athanasiou S, Chaliha C, Toozs-Hobson P, Salvatore S, Khullar V, Cardozo L (2007) Direct imaging of the pelvic floor muscles using two-dimensional ultrasound: a comparison of women with urogenital prolapse versus controls. BJOG 114(7):882–888

    Article  CAS  PubMed  Google Scholar 

  23. Haylen BT, Maher CF, Barber MD, Camargo S, Dandolu V, Digesu A, Goldman HB, Huser M, Milani AL, Moran PA, Schaer GN, Withagen MI (2016) An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic organ prolapse (POP). Int Urogynecol J Pelvic Floor Dysfunct 27(4):655–684

    Article  Google Scholar 

  24. Ingelman-Sundberg A, Ulmsten U (1983) Surgical treatment of female urinary stress incontinence. Contrib Gynecol Obstet 10:51–69

    CAS  PubMed  Google Scholar 

  25. Richardson AC, Edmonds PB, Williams NL (1981) Treatment of stress urinary incontinence due to paravaginal fascial defect. Obstet Gynecol 57(3):357–362

    CAS  PubMed  Google Scholar 

  26. Richardson AC, Lyon JB, Williams NL (1976) A new look at pelvic relaxation. Am J Obstet Gynecol 126(5):568–573

    Article  CAS  PubMed  Google Scholar 

  27. White GR (1909) Cystocele—a radical cure by suturing lateral sulci of the vagina to the white line of pelvic fascia. Int Urogynecol J Pelvic Floor Dysfunct 8(5):288–292

    Article  Google Scholar 

  28. Martan A, Masata J, Halaska M, Otcenásek M, Svabik K (2002) Ultrasound imaging of paravaginal defects in women with stress incontinence before and after paravaginal defect repair. Ultrasound Obstet Gynecol 19(5):496–500

    Article  CAS  PubMed  Google Scholar 

  29. Nguyen JK, Hall CD, Taber E, Bhatia NN (2000) Sonographic diagnosis of paravaginal defects: a standardization of technique. Int Urogynecol J Pelvic Floor Dysfunct 11(6):341–345

    Article  CAS  PubMed  Google Scholar 

  30. Ostrzenski A, Osborne NG (1998) Ultrasonography as a screening tool for paravaginal defects in women with stress incontinence: a pilot study. Int Urogynecol J Pelvic Floor Dysfunct 9(4):195–199

    Article  CAS  PubMed  Google Scholar 

  31. Huebner M, Margulies RU, DeLancey JO (2008) Pelvic architectural distortion is associated with pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct 19(6):863–867

    Article  PubMed  PubMed Central  Google Scholar 

  32. Tillack AA, Joe BN, Yeh BM, Jun SL, Kornak J, Zhao S, Deng D (2015) Vaginal shape at resting pelvic MRI: predictor of pelvic floor weakness? Clin Imaging 39(2):285–288

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

National Science Foundation of China is acknowledged for providing financial support to this work (No. 81571699).

Author information

Authors and Affiliations

Authors

Contributions

CD: project development, manuscript writing, data collection. QL: project development, data collection, manuscript writing. TY: conceptualization, funding acquisition. WS: data collection. YY: methodology. YL: data analysis. XW: data analysis.

Corresponding authors

Correspondence to Qin Li or Tao Ying.

Ethics declarations

Ethical approval

This study was approved by the Ethics Committee of Shanghai Jiao Tong University Affiliated Sixth People’s Hospital. All procedures performed in the study involving human participants were in accordance with the 1964 Helsinki declaration and its later amendments.

Conflict of interest

We declare that there are no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Dou, C., Li, Q., Ying, T. et al. Value of transperineal ultrasound on the observation of paravaginal support. Arch Gynecol Obstet 297, 943–949 (2018). https://doi.org/10.1007/s00404-018-4659-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-018-4659-y

Keywords

Navigation