Ultrasound in Obstetrics & Gynecology vol:30 pages:447-448
17th World Congress on Ultrasound in Obstetrics and Gynecology location:Florence, Italy date:7–11 October 2007
Objectives: The aim was to objectively evaluate pelvic floor contraction, avoiding existing invasive techniques. M
ethods: Some 369 patients referred to two tertiary clinics for pelvic floor complaints were retrospectively evaluated. 3D/4D volumes were obtained using a GE Kretz Voluson 730 Expert system in the supine position and after voiding at rest, maximal straining and on Valsalva. Subjective scores for pelvic floor muscle contraction were given on dynamic 3D and 4Dusing the standardized ICS terminology for assessment of pelvic muscle contraction (non-functioning, weak,normal or strong). Offline analysis of the datasets was undertaken using the software GE Kretz 4D View. Measurements were taken at the level of minimal hiatal dimensions using the inferior margin of the symphysis pubis as reference point on 2D and 3D datasets. On 2D ultrasound the diameter of the minimal anteroposterior (AP) hiatus, vertical displacement of the bladder neck and levator angle were measured. 3D datasets were used for obtaining AP and left–right diameter as well as area of the hiatus.
Results: Complete datasets were available for 349 women. The proportional difference (value A rest–value A contraction/value A rest) between the above parameters was calculated. There were significant correlations (P < 0.001) in all parameters between women with no, weak, normal or strong contractions except for vertical bladder neck displacement. The proportional 2D AP difference between rest and contraction measured in the 2D volume seemed to be the strongest predictor, followed by 3D AP diameter and hiatal area.
Conclusions: Proportional differences of the AP measurement between rest and contraction in 2D volumes is the easiest method for quantification of pelvic floor muscle contraction. Surprisingly,vertical bladder neck displacement did not seem to be significant between women with no, weak, normal or strong pelvic floor contractions.