Skip to main content
SpringerLink
Log in

Further Investigations and Follow-Up: Pelvic Floor Ultrasound

  • Chapter
  • First Online:
Childbirth Trauma

  • 1092 Accesses

Abstract

The purpose of this chapter is to describe the 3D ultrasonography’s utility in the assessment of pelvic floor trauma associated with vaginal delivery. These pathologies are associated with urinary incontinence and cystocele. 3D ultrasonography has been overlooked in favor of MR imaging. However, this technique can be a powerful tool in the hands of the obstetricians who suspect levator ani trauma.

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

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Lien K-C, DeLancey JOL, Ashton-Miller JA. Biomechanical analyses of the efficacy of patterns of maternal effort on second-stage progress. Obstet Gynecol. 2009;113(4):873–80.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Dietz HP, Shek C, Clarke B. Biometry of the pubovisceral muscle and levator hiatus by three-dimensional pelvic floor ultrasound. Ultrasound Obstet Gynecol. 2005;25(6):580–5.

    Article  CAS  PubMed  Google Scholar 

  4. Shobeiri SA, Rostaminia G, Quiroz LH. Relative contributions of the levator ani subdivisions to levator ani movement. Neurourol urodyn. 2013;32(6):710–11.

    Google Scholar 

  5. Ashton-Miller JA, Delancey JOL. On the biomechanics of vaginal birth and common sequelae. Ann Rev Biomed Eng. 2009;11:163–76.

    Article  CAS  Google Scholar 

  6. Sultan AH, Nicholls RJ, Kamm MA, Hudson CN, Beynon J, Bartram CI. Anal endosonography and correlation with in vitro and in vivo anatomy. Br J Surg. 1993;80(4):508–11.

    Article  CAS  PubMed  Google Scholar 

  7. Sultan AH, Kamm MA, Talbot IC, Nicholls RJ, Bartram CI. Anal endosonography for identifying external sphincter defects confirmed histologically. Br J Surg. 1994;81(3):463–5.

    Article  CAS  PubMed  Google Scholar 

  8. Sultan AH, Loder PB, Bartram CI, Kamm MA, Hudson CN. Vaginal endosonography. New approach to image the undisturbed anal sphincter. Dis Colon Rectum. 1994;37(12):1296–9.

    Article  CAS  PubMed  Google Scholar 

  9. Sultan AH, Monga AK, Stanton SL. The pelvic floor sequelae of childbirth. Br J Hosp Med. 1996;55(9):575–9.

    CAS  PubMed  Google Scholar 

  10. Sultan AH, Stanton SL. Preserving the pelvic floor and perineum during childbirth–elective caesarean section? Br J Obstet Gynaecol. 1996;103(8):731–4.

    Article  CAS  PubMed  Google Scholar 

  11. Strohbehn K, Ellis JH, Strohbehn JA, DeLancey JO. Magnetic resonance imaging of the levator ani with anatomic correlation. Obstet Gynecol. 1996;87(2):277–85.

    Article  CAS  PubMed  Google Scholar 

  12. Tunn R, DeLancey JO, Howard D, Thorp JM, Ashton-Miller JA, Quint LE. MR imaging of levator ani muscle recovery following vaginal delivery. Int Urogynecol J. 1999;10(5):300–7.

    Article  CAS  Google Scholar 

  13. Shobeiri SA, Nolan TE, Yordan-Jovet R, Echols KT, Chesson RR. Digital examination compared to trans-perineal ultrasound for the evaluation of anal sphincter repair. Int J Gynaecol Obstet. 2002;78(1):31–6.

    Article  CAS  PubMed  Google Scholar 

  14. Dietz HP, Lanzarone V. Levator trauma after vaginal delivery. Obstet Gynecol. 2005;106(4):707–12.

    Article  PubMed  Google Scholar 

  15. Dietz HP, Steensma AB. The prevalence of major abnormalities of the levator ani in urogynaecological patients. BJOG. 2006;113(2):225–30.

    Article  CAS  PubMed  Google Scholar 

  16. Weinstein MM, Pretorius DH, Jung SA, Nager CW, Mittal RK. Transperineal three-dimensional ultrasound imaging for detection of anatomic defects in the anal sphincter complex muscles. Clin Gastroenterol Hepatol. 2009;7(2):205–11.

    Article  PubMed  Google Scholar 

  17. Shek KL, Dietz HP. Intrapartum risk factors for levator trauma. BJOG. 2010;117(12):1485–92.

    Article  CAS  PubMed  Google Scholar 

  18. Dietz HP, Abbu A, Shek KL. The levator-urethra gap measurement: a more objective means of determining levator avulsion? Ultrasound Obstet Gynecol. 2008;32(7):941–5.

    Article  CAS  PubMed  Google Scholar 

  19. Zhuang RR, Song YF, Chen ZQ, Ma M, Huang HJ, Chen JH, et al. Levator avulsion using a tomographic ultrasound and magnetic resonance-based model. Am J Obstet Gynecol. 2011;205(3):232.e1–8.

    Article  Google Scholar 

  20. Shobeiri SA, Rostaminia G, White DE, Quiroz LH. The determinants of minimal levator hiatus and their relationship to the puborectalis muscle and the levator plate. BJOG. 2013;120(2):205–11.

    Article  PubMed  Google Scholar 

  21. 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;114:66–72.

    Article  PubMed  Google Scholar 

  22. Shobeiri SA, White D, Quiroz LH, Nihira MA. Anterior and posterior compartment 3D endovaginal ultrasound anatomy based on direct histologic comparison. Int Urogynecol J. 2012;23(8):1047–53.

    Article  PubMed  Google Scholar 

  23. 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 Pelvic Floor Dysfunct. 2011;22:53–9.

    Article  Google Scholar 

  24. 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.

    Article  Google Scholar 

  25. Shek KL, Dietz HP. Can levator avulsion be predicted antenatally? Am J Obstet Gynecol. 2010;202(6):586.e1–6.

    Article  Google Scholar 

  26. van Delft K, Thakar R, Shobeiri SA, Sultan AH. Levator haematoma at the attachment zone as an early marker for levator ani muscle avulsion. Ultrasound Obstet Gynecol. 2014;43(2):210–7.

    Article  PubMed  Google Scholar 

  27. 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.

    Article  CAS  PubMed  Google Scholar 

  28. 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.

    Article  PubMed  Google Scholar 

  29. Cassado Garriga J, Pessarrodona Isern A, Espuna Pons M, Duran Retamal M, Felgueroso Fabregas A, Rodriguez-Carballeira M. Tridimensional sonographic anatomical changes on pelvic floor muscle according to the type of delivery. Int Urogynecol J. 2011;22(8):1011–8.

    Article  PubMed  Google Scholar 

  30. Shek KL, Dietz HP. The effect of childbirth on hiatal dimensions. Obstet Gynecol. 2009;113(6):1272–8.

    Article  PubMed  Google Scholar 

  31. 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.

    Article  CAS  PubMed  Google Scholar 

  32. Stankiewicz A, Wieczorek A, Wozniak M. Comparison of accuracy of functional measurements of the urethra in transperineal vs. endovaginal ultrasound in incontinent women. Peliperineology. 2008;27:145–7.

    Google Scholar 

  33. 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.

    Article  PubMed  Google Scholar 

  34. Morgan DM, Umek W, Stein T, Hsu Y, Guire K, DeLancey JOL. Interrater reliability of assessing levator ani muscle defects with magnetic resonance images. Int Urogynecol J. 2007;18(7):773–8.

    Article  Google Scholar 

  35. White D, Rostaminia G, Quiroz L, Shobeiri S. Sonographic predictors of obstructive defecatory dysfunction. Neurourol Urodyn. 2013;32(6):707–9.

    Google Scholar 

  36. Rostaminia G, White DE, Quiroz LH, Shobeiri SA. Visualization of periurethral structures by 3D endovaginal ultrasonography in midsagittal plane is not associated with stress urinary incontinence status. Int Urogynecol J. 2013;24(7):1145–50.

    Article  CAS  PubMed  Google Scholar 

  37. Rostaminia G, White D, Quiroz L, Shobeiri S. Levator plate descent correlates with levator ani muscle deficiency. Int Urogynecol J. 2012;23 Suppl 2:S43–244. doi:10.1007/s00192-012-1875-z.

    Google Scholar 

  38. Volloyhaug I, Wong V, Shek KL, Dietz HP. Does levator avulsion cause distension of the genital hiatus and perineal body? Int Urogynecol J. 2012;27:27.

    Google Scholar 

  39. Toozs-Hobson P, Balmforth J, Cardozo L, Khullar V, Athanasiou S. The effect of mode of delivery on pelvic floor functional anatomy. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(3):407–16.

    Article  PubMed  Google Scholar 

  40. Falkert A, Endress E, Weigl M, Seelbach-Gobel B. Three-dimensional ultrasound of the pelvic floor 2 days after first delivery: influence of constitutional and obstetric factors. Ultrasound Obstet Gynecol. 2010;35(5):583–8.

    Article  CAS  PubMed  Google Scholar 

  41. Shek KL, Kruger J, Dietz HP. The effect of pregnancy on hiatal dimensions and urethral mobility: an observational study. Int Urogynecol J. 2012;23(11):1561–7.

    Article  PubMed  Google Scholar 

  42. Chantarasorn V, Shek KL, Dietz HP. Mobility of the perineal body and anorectal junction before and after childbirth. Int Urogynecol J. 2012;23(6):729–33.

    Article  PubMed  Google Scholar 

  43. van Delft K, Shobeiri SA, Thakar R, Schwertner-Tiepelmann N, Sultan AH. Intra- and inter-rater reliability of levator ani muscle biometry and avulsion using three-dimensional endovaginal sonography. Ultrasound Obstet Gynecol. 2014;43(2):202–9.

    Article  PubMed  Google Scholar 

  44. Dietz HP, Simpson JM. Does delayed child-bearing increase the risk of levator injury in labour? Aust N Z J Obstet Gynaecol. 2007;47(6):491–5.

    Article  PubMed  Google Scholar 

  45. Albrich S, Laterza RM, Merinsky A, Skala C, Koelbl H, Naumann G. Measurement of the infrapubic angle using 3D perineal ultrasound and its relationship to obstetrical parameters. Ultraschall in der Medizin (Stuttgart, Germany, 1980). 2012;33(7):E95–100.

    Google Scholar 

  46. Ashton-Miller JA, Delancey JOL. Functional anatomy of the female pelvic floor. Ann N Y Acad Sci. 2007;1101(1):266–96.

    Article  PubMed  Google Scholar 

  47. 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(1):19–22.

    Article  PubMed  PubMed Central  Google Scholar 

  48. DeLancey JO, 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.

    Article  PubMed  Google Scholar 

  49. Dietz HP. Quantification of major morphological abnormalities of the levator ani. Ultrasound Obstet Gynecol. 2007;29(3):329–34.

    Article  CAS  PubMed  Google Scholar 

  50. Dietz HP, Simpson JM. Levator trauma is associated with pelvic organ prolapse. BJOG. 2008;115(8):979–84.

    Article  CAS  PubMed  Google Scholar 

  51. Dietz HP, Kirby A, Shek KL, Bedwell PJ. Does avulsion of the puborectalis muscle affect bladder function? Int Urogynecol J Pelvic Floor Dysfunct. 2009;20(8):967–72.

    Article  CAS  PubMed  Google Scholar 

  52. Morgan DM, Cardoza P, Guire K, Fenner DE, DeLancey JO. Levator ani defect status and lower urinary tract symptoms in women with pelvic organ prolapse. Int Urogynecol J. 2010;21(1):47–52.

    Article  PubMed  Google Scholar 

  53. 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.

    PubMed  PubMed Central  Google Scholar 

  54. DeLancey JOL, Trowbridge ER, Miller JM, Morgan DM, Guire K, Fenner DE, et al. Stress urinary incontinence: relative importance of urethral support and urethral closure pressure. J Urol. 2008;179(6):2286–90; discussion 90.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Zufferey G, Perneger T, Robert-Yap J, Rubay R, Lkhagvabayar B, Roche B. Measure of the voluntary contraction of the puborectal sling as a predictor of successful sphincter repair in the treatment of anal incontinence. Dis Colon Rectum. 2009;52(4):704–10.

    Article  PubMed  Google Scholar 

  56. Chantarasorn V, Shek KL, Dietz HP. Sonographic detection of puborectalis muscle avulsion is not associated with anal incontinence. Aust N Z J Obstet Gynaecol. 2011;51(2):130–5.

    Article  PubMed  Google Scholar 

  57. Bharucha AE, Fletcher JG, Melton 3rd LJ, Zinsmeister AR. Obstetric trauma, pelvic floor injury and fecal incontinence: a population-based case-control study. Am J Gastroenterol. 2012;107(6):902–11.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Shobeiri SA. The practical value of the levator ani muscle subdivisions in endovaginal three-dimensional ultrasonography. Obstet Gynecol. 2009;114:1145–6.

    Article  Google Scholar 

  59. Fernando RJ, Sultan AH, Radley S, Jones PW, Johanson RB. Management of obstetric anal sphincter injury: a systematic review and national practice survey. BMC Health Serv Res. 2002;2(9):1–10.

    Google Scholar 

  60. Dietz HP, Gillespie AVL, 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.

    Article  PubMed  Google Scholar 

  61. Rostaminia G, Shobeiri SA, Quiroz LH. Surgical repair of bilateral levator ani muscles with ultrasound guidance. Int Urogynecol J. 2013;24(7):1237–9.

    Article  PubMed  Google Scholar 

  62. 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.

    Article  PubMed  Google Scholar 

  63. Schwertner-Tiepelmann N, Thakar R, Sultan AH, Tunn R. Obstetric levator ani muscle injuries: current status. Ultrasound Obstet Gynecol. 2012;39(4):372–83.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Inova Fairfax Hospital, 3300 Gallows Rd, Falls Church, VA, 22042, USA

    Ghazaleh Rostami Nia MD

  2. Gynecologic subspecialties, Inova Fairfax Hospital, 3300 Gallows Rd, Falls Church, VA, 22042, USA

    S. Abbas Shobeiri MD (Professor, Vice Chairman)

Authors
  1. Ghazaleh Rostami Nia MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. Abbas Shobeiri MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S. Abbas Shobeiri MD .

Editor information

Editors and Affiliations

  1. St George's University of London, London, United Kingdom

    Stergios K Doumouchtsis

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer-Verlag London

About this chapter

Cite this chapter

Nia, G.R., Shobeiri, S.A. (2017). Further Investigations and Follow-Up: Pelvic Floor Ultrasound. In: Doumouchtsis, S. (eds) Childbirth Trauma. Springer, London. https://doi.org/10.1007/978-1-4471-6711-2_10

Download citation

  • DOI: https://doi.org/10.1007/978-1-4471-6711-2_10

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-6710-5

  • Online ISBN: 978-1-4471-6711-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation