ArticleInternational urogynecology journal2026
Image-Quality Assessment of the Levator Ani Immediately After Delivery.
Article in International urogynecology journal, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introduction and hypothesisVaginal childbirth may cause levator ani muscle (LAM) avulsion and hiatal widening. 3D/4D transperineal ultrasound (TPUS) is widely used to assess the hiatal area and insertion of the LAM. We aimed to assess the quality of TPUS images for assessing the above when acquisitions were done immediately after vaginal childbirth.
methodsSecondary analysis of images obtained after vaginal birth by experienced sonographers, in 100 randomly selected patients from two prospective cohort studies, was carried out. In those, TPUS volumes were acquired immediately after vaginal delivery at rest, during contraction of the pelvic floor muscles, and during Valsalva. Two investigators independently rated the image quality for visibility of midsagittal landmarks (symphysis, urethra, levator ani; yes/no), quality of visualization using a three-point Likert scale of the LAM in the axial plane and on tomographic ultrasound images (TUI), and visualization of the pubic symphysis and insertion points of the LAM. Sixty random volumes with adequate/ideal image quality were selected for intra- and inter-rater agreement of hiatal dimension measurements.
resultsIn the midsagittal plane, all landmarks were visible in over 83% of TPUS volumes. "Ideal" or "adequate" visualization of the LAM in the axial plane was achieved in 50% and 40% respectively. Ideal visualization was highest during contraction of the pelvic floor muscles (63%). In TUI, the symphysis was visualized "ideally" or "adequately" in 71% or 22%, right LAM insertion in 73% or 19%, and left LAM insertion in 72% and 20% respectively. Hiatal dimension measurements showed excellent intra- and inter-rater agreement.
conclusionsThe quality of TPUS images obtained immediately after birth was adequate to ideal in over 90% of acquisitions.
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