Clinical Study Of Pelvic Organ Prolapse By Using Three-Dimensional Transperineal Ultrasound Combined With Strain Elastography

Objective: To evaluate the value of transperineal pelvic floor three-dimensional ultrasound combined with strain elastography imaging in the diagnosis of postpartum women with anterior pelvic organ prolapse and the contractility of pelvic floor muscles.Methods: Transperineal pelvic floor three-dimensional ultrasound and strain elastography was performed on postpartum women 6 to 12 weeks after parturition(postpartum group).Used the central axis line of the symphysis pubis as the baseline,of which the line at an angle of 135 degrees was used as the reference line.Measured distance from bladder neck to reference line,retro-vesical angle,tilt angle of urethra and area of levator ani muscle hiatus at resting and Valsalva maneuver,as well as movement degree of bladder neck,distance of the posterior wall of the bladder from the reference line and rotate angle of urethra(difference in tilt angle of urethra between resting and Valsalva maneuver),etc.Then conventional perineal ultrasound was used to respectively locate the puborectalis muscle and the perineal body for strain elastography.Strain value of puborectalis muscle and perineal body was obtained.Compared with healthy adult women without pregnancy(control group)to assess the anterior pelvic organ prolapsed of the postpartum women.Results: The movement degree of bladder neck,tilt and rotation angle of urethra,area of levator ani muscle hiatus,maximum strain of pubic rectum muscle and perineal body in postpartum group was higher than those in control group.Distance from bladder neck to reference line,the movement degree of bladder neck,tilt and rotation angle of urethra,area of levator ani muscle hiatus,distance of the posterior wall of the bladder from the reference line,retro-vesical angle(Valsalva maneuver)and the maximum strain of pubic rectum muscle and perineal body are related to the anterior pelvic organ prolapse on univariate analysis.The distance from bladder neck to reference line(Valsalva maneuver),retro-vesical angle(Valsalva maneuver)and maximum strain of perineal body are correlated with the anterior pelvic organ prolapse on multivariate analysis.Spearman correlation analysis showed that the maximum strain of the puborectalis muscle had no correlation with the distance from bladder neck to reference line(Valsalva maneuver),retro-vesical angle(Valsalva maneuver)and the area of levator ani muscle hiatus(all p >0.05).There was no correlation between the maximal strain of the perineal body and the distance from bladder neck to reference line(Valsalva maneuver),the retro-vesical angle(Valsalva maneuver),and the area of levator ani muscle hiatus(all p > 0.05).There was a correlation between perineal body strain and puborectalis strain(p = 0.028).After Valsalva maneuver,the area of levator ani muscle hiatus was correlated with the distance from bladder neck to reference line(p = 0.000)and the retro-vesical angle(Valsalva maneuver)is related to the distance from bladder neck to reference line(p = 0.002).Friedman multifactor correlation analysis showed that there were correlations among all ultrasound indicators(p = 0.000).There were statistically significant differences in the area oflevator ani muscle hiatus and distance from bladder neck to reference line between women with vaginal deliveries and cesarean section(all p < 0.05),but no statistically significant differences in other parameters.Compared with women with multiple and first vaginal deliveries,all measured parameters were not statistically significant(all p >0.05).According to the receiver operating characteristic curve,the area under curve of theretro-vesical angle(Valsalva maneuver),the movement degree of bladder neck and urethral inclination angle(Valsalva motion)in the diagnosis of anterior pelvic organ prolapse was 0.771(95% CI 67.3% ? 86.9%),0.760(95% CI 66.6% ? 85.5%)and 0.797(95% CI 70.6% ? 88.8%),respectively.With the retro-vesical angle(Valsalva maneuver)133.5,the movement degree of bladder neck 25.05 mm and urethral inclination angle(Valsalva motion)65.6 as the cut-off value,the sensitivity and specificity for the diagnosis of anterior pelvic organ prolapse were 75.8% and 76.2%,62.1% and 81.0%,74.1% and 85.7%,respectively.Conclusion(s): The three-dimensional perineal pelvic floor ultrasound can display and measure the size of levator ani muscle hiatus and the movement degree of bladder neck and urethra and improve the accuracy of the diagnosis of anterior pelvic organ prolapse.Combined with strain elastography,it can effectively assess the hardness of pelvic floor muscles and predict the contractility of pelvic floor muscles,which is conducive to improving the accuracy of assessing the risk of pelvic organ prolapse in postpartum women,and has guiding value for clinicians to choose and formulate reasonable intervention measures.