Unraveling the Pelvic Floor:Obstetric injury, Symptoms and Imaging Techniques

Research into risk factors for the development of pelvic floor (residual) injury and urogynecological complaints after a vaginal delivery with and without obstetric anal sphincter injury. Comparison between conventional perineal pelvic floor ultrasound and virtual reality imaging of the pelvic floor

Postpartum sexual function; the importance of the levator ani muscle

Introduction and hypothesis Pelvic floor muscle function plays an important role in female sexual functioning. Smaller genital hiatal dimensions have been associated with sexual dysfunction, mainly dyspareunia. On the other hand, trauma of the levator ani muscle sustained during childbirth is associated with increased genital hiatus, which potentially can affect sexual functioning by causing vaginal laxity. This study aims to determine the association between levator hiatal dimensions and female sexual dysfunction after first vaginal delivery. Methods This is a secondary analysis of a prospective observational study. Two hundred four women who had a first, spontaneous vaginal delivery at term between 2012 and 2015 were recruited at a minimum of 6 months postpartum. Thirteen pregnant women were excluded. We analyzed the association of total PISQ-12 score, as well as individual sexual complaints (desire, arousal, orgasm and dyspareunia), with levator hiatal dimensions at rest, with maximum Valsalva and during pelvic floor muscle contraction as measured by 4D transperineal ultrasound. Statistical analysis was performed using linear regression analysis and Mann-Whitney U test. Results One hundred ninety-one women were evaluated at a median of 11 months postpartum. There was no significant as

[A full-term fetal death].

A 31-year-old woman came to the clinic in the 37th week of her pregnancy because she did not feel movements of the fetus anymore. It appeared intrauterine death had occurred because of strangulation of the umbilical cord by an amniotic band, which led to cardiocirculatory insufficiency of the fetus

Agreement and reliability of pelvic floor measurements during contraction using three-dimensional pelvic floor ultrasound and virtual reality

Objectives Virtual reality is a novel method of visualizing ultrasound data with the perception of depth and offers possibilities for measuring non-planar structures. The levator ani hiatus has both convex and concave aspects. The aim of this study was to compare levator ani hiatus volume measurements obtained with conventional three-dimensional (3D) ultrasound and with a virtual reality measurement technique and to establish their reliability and agreement. Methods 100 symptomatic patients visiting a tertiary pelvic floor clinic with a normal intact levator ani muscle diagnosed on translabial ultrasound were selected. Datasets were analyzed using a rendered volume with a slice thickness of 1.5 cm at the level of minimal hiatal dimensions during contraction. The levator area (in cm2) was measured and multiplied by 1.5 to get the levator ani hiatus volume in conventional 3D ultrasound (in cm3). Levator ani hiatus volume measurements were then measured semi-automatically in virtual reality (cm3) using a segmentation algorithm. An intra- and interobserver analysis of reliability and agreement was performed in 20 randomly chosen patients. Results The mean difference between levator ani hiatus volume measurements performed using conventional 3D ultrasound and virtual reality was 0.10 (95% CI, - 0.15 to 0.35) cm3. The intraclass correlation coefficient (ICC) comparing conventional 3D ultrasound with virtual reality measurements was > 0.96. Intra- and interobserver ICCs for conventional 3D ultrasound measurements were > 0.94 and for virtual reality measurements were > 0.97, indicating good reliability for both. Conclusion Levator ani hiatus volume measurements performed using virtual reality were reliable and the results were similar to those obtained with conventional 3D ultrasonography. Copyright (C) 2012 ISUOG. Published by John Wiley & Sons, Ltd

Amino-terminal pro-brain natriuretic peptide (NT-proBNP) is a biomarker of cardiac filling pressures in pre-eclampsia

Objective To evaluate if amino-terminal pro-brain natriuretic peptide (NT-proBNP) plasma levels reflect intracardiac filling pressures in pre-eclamptic patients Study design In a cross-sectional study we investigated 22 untreated critically ill pre-eclamptic women between 22 and 34 weeks gestation All patients underwent intra-arterial blood pressure and central hemodynamic measurements and NT-proBNP was determined in stored plasma Baseline characteristics plasma NT-proBNP concentrations and relevant laboratory variables were investigated for correlations with hemodynamic values using Spearman s rank correlation test Results No significant correlations were demonstrated between NT-proBNP concentrations and variables associated with the severity of the pre-eclampsia We found significant positive correlations between NT-proBNP and diastolic pulmonary pressure (r = 0 59 p = 0 005) and pulmonary capillary wedge pressure (PCWP) (r = 051 p = 0 015) Multiple linear regression analysis showed that the association between NT-proBNP and PCWP was not affected by creatinine level Conclusion NT-proBNP is a blomarker of left ventricular cardiac filling pressures in untreated pre-eclamptic patients (C) 2010 Elsevier Ireland Ltd All rights reserve