International Urogynecology Journal

, Volume 25, Issue 11, pp 1501–1506 | Cite as

Diagnosing levator avulsions after first delivery by tomographic ultrasound: reliability between observers from different centers

  • G. A. van VeelenEmail author
  • K. J. Schweitzer
  • K. van Delft
  • K. B. Kluivers
  • M. Weemhoff
  • C. H. van der Vaart
Original Article


Introduction and hypothesis

To evaluate the interobserver reliability of diagnosing levator avulsions between observers from different centers using tomographic ultrasound imaging (TUI) in women after their first delivery.


Transperineal ultrasound volume datasets of 40 women 6 months after their first delivery were analyzed by five observers from four different centers. Levator avulsions were diagnosed using TUI and datasets were assessed as optimal or suboptimal image quality and optimal or suboptimal pelvic floor contraction. Cohen’s kappa was used to evaluate the interobserver reliability of diagnosing levator avulsions for the total group, the group with optimal and suboptimal image quality, and the group with optimal and suboptimal pelvic floor contraction. Consensus on the presence or absence of avulsions was scored according to the number of observers who diagnosed an avulsion (0 = consensus on the absence of avulsion, 1–4 = avulsion diagnosed by 1 to 4 observers, 5 = consensus on the presence of avulsion).


For the total group, the interobserver reliability varied widely, with kappa values ranging from −0.07 to 0.72. Analyzes in the subgroups showed comparable results. Of the women who potentially have an avulsion (avulsion diagnosed by at least one observer), consensus on the presence of an avulsion was reached in 0.0 to 20.0 %. Of the women who potentially have no avulsion (no avulsion diagnosed by at least one observer), consensus on the absence of an avulsion was reached in 46.7 to 85.7 %.


Diagnosing levator avulsions using TUI in women 6 months after their first delivery is strongly observer-dependent and therefore not generalizable.


Interobserver reliability Levator avulsion Pelvic floor Postpartum Tomographic ultrasound imaging Transperineal ultrasound 


Conflicts of interest





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Copyright information

© The International Urogynecological Association 2014

Authors and Affiliations

  • G. A. van Veelen
    • 1
    Email author
  • K. J. Schweitzer
    • 1
  • K. van Delft
    • 2
  • K. B. Kluivers
    • 3
  • M. Weemhoff
    • 4
  • C. H. van der Vaart
    • 1
  1. 1.Department of Reproductive Medicine and GynecologyUniversity Medical Center UtrechtUtrechtThe Netherlands
  2. 2.Department of Obstetrics and GynecologyCroydon University HospitalCroydonUK
  3. 3.Department of Obstetrics and GynecologyRadboud University Medical CentreNijmegenThe Netherlands
  4. 4.Department of Obstetrics and GynecologyMaastricht University Medical CentreMaastrichtThe Netherlands

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