Abstract
Introduction and hypothesis
Childbirth-related morphological abnormalities or defects of the puborectalis muscle (“avulsion”) can be diagnosed by magnetic resonance imaging and three-dimensional (3D) ultrasound, but neither method is universally available. In this study, we tested validity and reproducibility of a new method for diagnosing levator avulsion by 2D translabial ultrasound.
Methods
Seventy-five women were examined for major morphological abnormalities of the puborectalis muscle by palpation, 2D and 3D ultrasound (US). For 2D US, we used an oblique parasagittal translabial approach. The operator using 2D US was blinded against all other findings.
Results
Agreement between observers for diagnosis of avulsion by 2D US was 87% (Cohen’s kappa 0.56, CI 0.33–0.80). Agreement between tomographic 3D US and 2D US was 87% (kappa 0.61, CI 0.45–0.77).
Conclusions
Defects of the puborectalis muscle can be diagnosed with 2D US. The finding of a discontinuity between the hyperechogenic muscle and the pelvic sidewall is moderately reproducible and agrees moderately well with palpation and 3D US.
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Acknowledgments
Prof. H.P. Dietz has received honoraria as a speaker from GE and AMS and has acted as consultant for CCS and AMS. He has also received equipment loans from GE, Toshiba and Bruel & Kjaer. Dr. K.L. Shek has no conflict of interest to declare.
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Dietz, H.P., Shek, K.L. Levator defects can be detected by 2D translabial ultrasound. Int Urogynecol J 20, 807–811 (2009). https://doi.org/10.1007/s00192-009-0839-4
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DOI: https://doi.org/10.1007/s00192-009-0839-4