3D Endovaginal Ultrasound Imaging of Pelvic Floor Trauma

  • Kim W. M. Van Delft
  • Ghazaleh Rostaminia
  • S. Abbas Shobeiri
Chapter

Abstract

The complex levator ani anatomy is perhaps best visualized with three-dimensional endovaginal ultrasonography. In this chapter we will address the occurrence of levator ani muscle injury during childbirth, and investigate the role of pelvic ultrasound to identify and quantify the amount of birth-related levator ani muscle trauma.

Keywords

Pelvic floor trauma Levator ani trauma Endovaginal ultrasound 

References

  1. 1.
    Lien KC, Mooney B, DeLancey JO, Ashton-Miller JA. Levator ani muscle stretch induced by simulated vaginal birth. Obstet Gynecol. 2004;103(1):31–40.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Lien KC, DeLancey JO, Ashton-Miller JA. Biomechanical analyses of the efficacy of patterns of maternal effort on second-stage progress. Obstet Gynecol. 2009;113(4):873–80.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Ashton-Miller JA, Delancey JO. On the biomechanics of vaginal birth and common sequelae. Annu Rev Biomed Eng. 2009;11:163–76.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Alperin M, Lawley DM, Esparza MC, Lieber RL. Pregnancy-induced adaptations in the intrinsic structure of rat pelvic floor muscles. Am J Obstet Gynecol. 2015;213(2):191.e1–7.CrossRefGoogle Scholar
  5. 5.
    Schwertner-Tiepelmann N, Thakar R, Sultan AH, Tunn R. Obstetric levator ani muscle injuries: current status. Ultrasound Obstet Gynecol. 2012;39(4):372–83.CrossRefPubMedGoogle Scholar
  6. 6.
    van Delft K, Thakar R, Shobeiri SA, Sultan AH. Levator hematoma at the attachment zone as an early marker for levator ani muscle avulsion. Ultrasound Obstet Gynecol. 2014;43(2):210–7.CrossRefPubMedGoogle Scholar
  7. 7.
    Shobeiri SA, Leclaire E, Nihira MA, Quiroz LH, O’Donoghue D. Appearance of the levator ani muscle subdivisions in endovaginal three-dimensional ultrasonography. Obstet Gynecol. 2009;114(1):66–72.CrossRefPubMedGoogle Scholar
  8. 8.
    Santoro GA, Wieczorek AP, Stankiewicz A, Wozniak MM, Bogusiewicz M, Rechberger T. High-resolution three-dimensional endovaginal ultrasonography in the assessment of pelvic floor anatomy: a preliminary study. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20(10):1213–22.CrossRefPubMedGoogle Scholar
  9. 9.
    Santoro GA, Wieczorek AP, Dietz HP, Mellgren A, Sultan AH, Shobeiri SA, et al. State of the art: an integrated approach to pelvic floor ultrasonography. Ultrasound Obstet Gynecol. 2011;37(4):381–96.CrossRefPubMedGoogle Scholar
  10. 10.
    Santoro GA, Wieczorek AP, Shobeiri SA, Mueller ER, Pilat J, Stankiewicz A, et al. Interobserver and interdisciplinary reproducibility of 3D endovaginal ultrasound assessment of pelvic floor anatomy. Int Urogynecol J. 2011;22(1):53–9.CrossRefPubMedGoogle Scholar
  11. 11.
    van Delft K, Shobeiri SA, Thakar R, Schwertner-Tiepelmann N, Sultan AH. Intra- and interobserver reliability of levator ani muscle biometry and avulsion using three-dimensional endovaginal ultrasonography. Ultrasound Obstet Gynecol. 2014;43(2):202–9.CrossRefPubMedGoogle Scholar
  12. 12.
    Kearney R, Sawhney R, DeLancey JO. Levator ani muscle anatomy evaluated by origin-insertion pairs. Obstet Gynecol. 2004;104(1):168–73.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Morgan DM, Umek W, Stein T, Hsu Y, Guire K, DeLancey JO. Interrater reliability of assessing levator ani muscle defects with magnetic resonance images. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18(7):773–8.CrossRefPubMedGoogle Scholar
  14. 14.
    Valsky DV, Lipschuetz M, Bord A, Eldar I, Messing B, Hochner-Celnikier D, et al. Fetal head circumference and length of second stage of labor are risk factors for levator ani muscle injury, diagnosed by 3-dimensional transperineal ultrasound in primiparous women. Am J Obstet Gynecol. 2009;201(1):91.e1–7.CrossRefGoogle Scholar
  15. 15.
    Richter HG, Tome MM, Yulis CR, Vio KJ, Jimenez AJ, Perez-Figares JM, et al. Transcription of SCO-spondin in the subcommissural organ: evidence for down-regulation mediated by serotonin. Brain Res Mol Brain Res. 2004;129(1–2):151–62.CrossRefPubMedGoogle Scholar
  16. 16.
    Model AN, Shek KL, Dietz HP. Levator defects are associated with prolapse after pelvic floor surgery. Eur J Obstet Gynecol Reprod Biol. 2010;153(2):220–3.CrossRefPubMedGoogle Scholar
  17. 17.
    Martin JF, Trowbridge EA. Theoretical requirements for the density separation of platelets with comparison of continuous and discontinuous gradients. Thromb Res. 1982;27(5):513–22.CrossRefPubMedGoogle Scholar
  18. 18.
    Albrich SB, Laterza RM, Skala C, Salvatore S, Koelbl H, Naumann G. Impact of mode of delivery on levator morphology: a prospective observational study with three-dimensional ultrasound early in the postpartum period. BJOG. 2012;119(1):51–60.CrossRefPubMedGoogle Scholar
  19. 19.
    van Delft K, Schwertner-Tiepelmann N, Thakar R, Sultan AH. Inter-rater reliability of assessment of levator ani muscle strength and attachment to the pubic bone in nulliparous women. Ultrasound Obstet Gynecol. 2013;42(3):341–6.CrossRefPubMedGoogle Scholar
  20. 20.
    Kim J, Ramanah R, DeLancey JO, Ashton-Miller JA. On the anatomy and histology of the pubovisceral muscle enthesis in women. Neurourol Urodyn. 2011;30(7):1366–70.PubMedPubMedCentralGoogle Scholar
  21. 21.
    Drewes PG, Yanagisawa H, Starcher B, Hornstra I, Csiszar K, Marinis SI, et al. Pelvic organ prolapse in fibulin-5 knockout mice: pregnancy-induced changes in elastic fiber homeostasis in mouse vagina. Am J Pathol. 2007;170(2):578–89.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Chan SS, Cheung RY, Yiu AK, Lee LL, Pang AW, Choy KW, et al. Prevalence of levator ani muscle injury in Chinese women after first delivery. Ultrasound Obstet Gynecol. 2012;39(6):704–9.CrossRefPubMedGoogle Scholar
  23. 23.
    Shek KL, Dietz HP. Intrapartum risk factors for levator trauma. BJOG. 2010;117(12):1485–92.CrossRefPubMedGoogle Scholar
  24. 24.
    Krofta L, Otcenasek M, Kasikova E, Feyereisl J. Pubococcygeus-puborectalis trauma after forceps delivery: evaluation of the levator ani muscle with 3D/4D ultrasound. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20(10):1175–81.CrossRefPubMedGoogle Scholar
  25. 25.
    van Delft K, Thakar R, Sultan A, Schwertner-Tiepelmann N, Kluivers K. Levator ani muscle avulsion during childbirth: a risk prediction model. BJOG. 2014;121(9):1155–63.CrossRefPubMedGoogle Scholar
  26. 26.
    Kearney R, Fitzpatrick M, Brennan S, Behan M, Miller J, Keane D, et al. Levator ani injury in primiparous women with forceps delivery for fetal distress, forceps for second stage arrest, and spontaneous delivery. Int J Gynaecol Obstet. 2010;111:19–22.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Kearney R, Miller JM, Ashton-Miller JA, DeLancey JO. Obstetric factors associated with levator ani muscle injury after vaginal birth. Obstet Gynecol. 2006;107(1):144–9.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Shek KL, Dietz HP. Can levator avulsion be predicted antenatally? Am J Obstet Gynecol. 2010;202(6):586.e1–6.CrossRefGoogle Scholar
  29. 29.
    Rostaminia G, Peck J, van Delft K, Thakar R, Sultan A, Shobeiri SA. New measures for predicting birth related pelvic floor trauma. (American Urogynecologic Society Conference Submissions). Female Pelvic Med Reconstr Surg. 2016;22(5):292–6.CrossRefPubMedGoogle Scholar
  30. 30.
    Dietz HP, Gillespie AV, Phadke P. Avulsion of the pubovisceral muscle associated with large vaginal tear after normal vaginal delivery at term. Aust N Z J Obstet Gynaecol. 2007;47(4):341–4.CrossRefPubMedGoogle Scholar
  31. 31.
    Shobeiri SA, Chimpiri AR, Allen A, Nihira MA, Quiroz LH. Surgical reconstitution of a unilaterally avulsed symptomatic puborectalis muscle using autologous fascia lata. Obstet Gynecol. 2009;114(2 Pt 2):480–2.CrossRefPubMedGoogle Scholar
  32. 32.
    Rostaminia G, Shobeiri SA. Surgical repair of bilateral levator ani muscles with ultrasound guidance: reply. Int Urogynecol J. 2013;24(2):357–8.CrossRefPubMedGoogle Scholar
  33. 33.
    Hudson CN. Female genital prolapse and pelvic floor deficiency. Int J Color Dis. 1988;3(3):181–5.CrossRefGoogle Scholar
  34. 34.
    DeLancey JO, Kearney R, Chou Q, Speights S, Binno S. The appearance of levator ani muscle abnormalities in magnetic resonance images after vaginal delivery. Obstet Gynecol. 2003;101(1):46–53.PubMedPubMedCentralGoogle Scholar
  35. 35.
    Quinn MJ, Beynon J, Mortensen NJ, Smith PJ. Transvaginal endosonography: a new method to study the anatomy of the lower urinary tract in urinary stress incontinence. Br J Urol. 1988;62(5):414–8.CrossRefPubMedGoogle Scholar
  36. 36.
    Branham V, Thomas J, Jaffe T, Crockett M, South M, Jamison M, et al. Levator ani abnormality 6 weeks after delivery persists at 6 months. Am J Obstet Gynecol. 2007;197(1):65.e1–6.CrossRefGoogle Scholar
  37. 37.
    Topps D, Evans RJ, Thistlethwaite JE, Nan Tie R, Ellaway RH. The one minute mentor: a pilot study assessing medical students’ and residents’ professional behaviours through recordings of clinical preceptors’ immediate feedback. Educ Health (Abingdon). 2009;22(1):189.Google Scholar
  38. 38.
    Russell PC. The white coat ceremony: turning trust into entitlement. Teach Learn Med. 2002;14(1):56–9.CrossRefPubMedGoogle Scholar
  39. 39.
    Dietz HP, Lanzarone V. Levator trauma after vaginal delivery. Obstet Gynecol. 2005;106(4):707–12.CrossRefPubMedGoogle Scholar
  40. 40.
    Dietz HP, Simpson JM. Levator trauma is associated with pelvic organ prolapse. BJOG. 2008;115(8):979–84.CrossRefPubMedGoogle Scholar
  41. 41.
    Dietz HP. Quantification of major morphological abnormalities of the levator ani. Ultrasound Obstet Gynecol. 2007;29(3):329–34.CrossRefPubMedGoogle Scholar
  42. 42.
    DeLancey JOL, Morgan DM, Fenner DE, Kearney R, Guire K, Miller JM, et al. Comparison of levator ani muscle defects and function in women with and without pelvic organ prolapse. Obstet Gynecol. 2007;109(2 Pt 1):295–302.CrossRefPubMedGoogle Scholar
  43. 43.
    Miller JM, Brandon C, Jacobson JA, Low LK, Zielinski R, Ashton-Miller J, et al. MRI findings in patients considered high risk for pelvic floor injury studied serially after vaginal childbirth. AJR Am J Roentgenol. 2010;195(3):786–91.CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Rostaminia G, Manonai J, Leclaire E, Omoumi F, Marchiorlatti M, Quiroz LH, et al. Interrater reliability of assessing levator ani deficiency with 360 degrees 3D endovaginal ultrasound. Int Urogynecol J. 2014;25(6):761–6.CrossRefPubMedGoogle Scholar
  45. 45.
    Javadian P, O’Leary D, Rostaminia G, North J, Wagner J, Quiroz LH, et al. How does 3D endovaginal ultrasound compare to magnetic resonance imaging in the evaluation of levator ani anatomy? Neurourol Urodyn. 2015; doi: 10.1002/nau.22944.. [Epub ahead of print]PubMedGoogle Scholar
  46. 46.
    Rostaminia G, Peck JD, Quiroz LH, Shobeiri SA. How well can levator ani muscle morphology on 3D pelvic floor ultrasound predict the levator ani muscle function? Int Urogynecol J. 2015;26(2):257–62.CrossRefPubMedGoogle Scholar
  47. 47.
    Rostaminia G, Peck J, Quiroz L, Shobeiri SA. Levator plate upward lift on dynamic sonography and levator muscle strength. J Ultrasound Med. 2015;34(10):1787–92.CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Rostaminia G, White D, Hegde A, Quiroz LH, Davila GW, Shobeiri SA. Levator ani deficiency and pelvic organ prolapse severity. Obstet Gynecol. 2013;121(5):1017–24.CrossRefPubMedGoogle Scholar
  49. 49.
    Rostaminia G, White DE, Quiroz LH, Shobeiri SA. Levator plate descent correlates with levator ani muscle deficiency. Neurourol Urodyn. 2015;34(1):55–9.CrossRefPubMedGoogle Scholar
  50. 50.
    O’Leary D, Rostaminia G, Quiroz LH, Shobeiri SA. Sonographic predictors of obstructive defecatory dysfunction. Int Urogynecol J. 2015;26(3):415–20.CrossRefPubMedGoogle Scholar
  51. 51.
    Rostaminia G, White D, Quiroz LH, Shobeiri SA. 3D pelvic floor ultrasound findings and severity of anal incontinence. Int Urogynecol J. 2014;25(5):623–9.CrossRefPubMedGoogle Scholar
  52. 52.
    Santiago AC, O’Leary DE, Quiroz LH, Shobeiri SA. Is there a correlation between levator ani and urethral sphincter complex status on 3D ultrasonography? Int Urogynecol J. 2015;26(5):699–705.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  • Kim W. M. Van Delft
    • 1
  • Ghazaleh Rostaminia
    • 2
  • S. Abbas Shobeiri
    • 3
    • 4
  1. 1.Department of Obstetrics and GynecologyRadboud University Nijmegen Medical CentreNijmegenThe Netherlands
  2. 2.Department of Obstetrics and GynecologyINOVA Women’s Hospital, Virginia Commonwealth UniversityFalls ChurchUSA
  3. 3.Department of Obstetrics and GynecologyGynecologic Subspecialties, INOVA Women’s Hospital, Virginia Commonwealth UniversityFalls ChurchUSA
  4. 4.Department of BioengineeringGeorge Mason UniversityFairfaxUSA

Personalised recommendations