Transvaginal Two‐Dimensional Ultrasound Evaluation as a Screening Tool for Levator ani Muscle Avulsion in Postpartum Women

Abstract

Objectives-To evaluate the agreement between two-dimensional transvaginal ultrasound (2D-TVUS) and transperineal tomographic ultrasound imaging on three-dimensional (3D) volume in diagnosing levator ani muscle (LAM) avulsion of postpartum women. Furthermore, we tested the repeatability of the 2D-TVUS in measuring the LAM thickness.Methods-A retrospective study was performed using the data sets from postpartum women. One doctor measured the thickness of the LAM on the images at the attachment to the arcus tendinous levator ani and the middle part using the 2D-TVUS ultrasound data sets of postpartum women. These women were examined twice, at 42-56 days and 3-6 months postpartum. Intra-observer repeatability was expressed using intraclass correlation coefficients (ICCs). The other doctor judged whether there was avulsion in the LAM on the 2D-TVUS and transperineal tomography imaging on the 3D volume. The inter-method agreement was determined using Cohen's kappa coefficient (k).Results-Thickness measurements of the middle part and attachment of the LAM by 2D-TVUS showed excellent and good intra-observer repeatability (ICC 0.84; 95% CI, 0.76-0.88, and ICC 0.74; 95% CI, 0.67-0.84, respectively). The overall agreement was 92% (Cohen's kappa was 0.79) between 2D-TVUS and transperineal tomographic imaging. Compared to transperineal tomographic imaging in the diagnosis of LAM avulsion, the diagnostic sensitivity of 2D-TVUS was 91.7%, the specificity was 92.1%.Conclusions-The 2D-TVUS technique, a simple and reproducible method for assessing LAM avulsion, may be helpful as a screening tool for LAM avulsion of postpartum women.

Is the Presence of Levator Ani Muscle Avulsion Relevant for the Diagnosis of Uterine Prolapse?

“…[36][37][38] Hence, the early diagnosis of LAM after childbirth is important, even when screening techniques are applied. 39 In our study, the detection of LAM avulsion was shown to be especially useful in the case of postmenopausal patients, improving the diagnostic capacity achieved by only the difference in the pubis-uterine fundus distance at rest and with the Valsalva maneuver. We believe it is possible that LAM avulsion and injuries of the uterosacral-cardinal ligament complex can occur in most cases at the same time and for the same cause (vaginal delivery).…”

“…The relationship that exists between pregnancy, childbirth, and changes in the pelvic floor has been described by different authors, 34,35 determining an association between LAM avulsion and prolapse symptoms 36–38 . Hence, the early diagnosis of LAM after childbirth is important, even when screening techniques are applied 39 . In our study, the detection of LAM avulsion was shown to be especially useful in the case of postmenopausal patients, improving the diagnostic capacity achieved by only the difference in the pubis‐uterine fundus distance at rest and with the Valsalva maneuver.…”

Feasibility and reproducibility of new technique for measurement of transverse diameter of levator ani muscle hiatus using two‐dimensional transperineal ultrasound in nulliparous women with term pregnancy

“…In contrast, 2D-TPUS can be executed readily using any convex transducer and requires less expertise and training compared with 3D-TPUS. Although certain studies have hinted at the potential of 2D-TPUS as a promising technique in evaluating LAM integrity 44,45 , the only LAM hiatal dimension measured on 2D-TPUS reported to date is the anteroposterior diameter 4,36,37 . Based on our findings, we propose that 2D-and 3D-TPUS methods can be used interchangeably for measuring LAM hiatal TD.…”