Search

Predicting the success of vaginal delivery is an important issue in preventing adverse maternal and neonatal outcomes. This study sought to examine whether measurement of the angle of progression (AoP) can predict a successful vaginal delivery following induction of labour (IoL) among late term nulliparous women with a low (4>) Bishop score. This prospective study included consecutive nulliparous pregnant women whose gestational age was 41 weeks and 1–6 days (late-term). The AoP was measured at least three times and their means were calculated. During the study period, data of 150 women were included in the final analysis. Thirty-eight women underwent CS due to failure to progress (n=30) or NRGHR (n=8), while the remaining 112 women underwent NVD, with four women requiring vacuum extraction. The two groups were similar with respect to age, gestational age, BMI, estimated foetal weight, and birth weight. Women undergoing NVD differed significantly from those undergoing CS with respect to a greater ultrasonographic AoP (113.8±11.9° vs. 98.1±10.9°, p=0.0001), a shorter duration of dinoprostone use, shorter time to labour contraction, and a shorter duration of labour. In ROC analysis, the cut-off value for AoP was 100° for the prediction of successful IoL for NVD, with a sensitivity of 96 % and a specificity of 63 %. AoP may be a useful sonographic parameter for predicting successful vaginal delivery among nulliparous women at late term undergoing IoL; an AOP wider than 100° is associated with a high rate of vaginal delivery. [ABSTRACT FROM AUTHOR]

Introduction: and hypothesis. We evaluated different bladder parameters using Transperineal Ultrasound (TPUS) in patients with apical pelvic organ prolapse undergoing lateral suspension or sacropexy. Methods: We included 73 cases with 37 cases in lateral suspension (LS) group and 36 cases in sacropexy group. We enrolled cases with apical prolapse stage 2 or higher according to Pelvic Organ Prolapse Quantification system (POP-Q). Evaluation done of all cases using TPUS preoperatively and at 6, 12 and 18 months follow-up visits. Results: In LS group we found significant differences postoperatively in bladder neck height (Dy distance) at Valsalva and rest (P value < 0.001 in both) and in β angle at Valsalva and rest (P value < 0.001 in both). There was significant improvement in PVR (P value < 0.001). In sacropexy group we found no significant differences postoperatively in bladder neck height at Valsalva (P value 0.07) or in β angle at Valsalva (P value 0.097). There was significant improvement in PVR (P value 0.006). In between the 2 groups, there was better improvement in LS group than sacropexy group in bladder neck height at rest (P value 0.001) and in β angle both at Valsalva and rest (P value < 0.001 & 0.002 respectively). There was no significant difference in PVR, bladder wall thickness or bladder neck funnelling. Conclusion: LS and sacropexy showed good postoperative improvement in some bladder parameters using TPUS with better improvement in bladder neck height in LS. Clinical Trial Registration: Clinical trial ID: NCT03772691. [ABSTRACT FROM AUTHOR]

Introduction: There is evolving literature on the superiority of transperineal ultrasound (TPU) in predicting the mode of delivery either before induction or during the course of labour. An ultrasound score (USG score) similar to a Bishop score or an ultrasound scoring method based on independent predictors before the onset of labour at term gestation would serve as a baseline objective record over which further progress of labour could be evaluated. Objective: 1. To sonographically examine the clinical parameters evaluated during a digital examination. 2. To derive an USG score using TPU parameters, similar to a Bishop score, and determine its performance in predicting pregnancy outcomes. 3. To identify which are the independent predictors of caesarean section among all the studied ultrasound (USG) parameters. Materials and methods: In this prospective study, all the eligible women who came for routine antenatal care at term gestation and who were due for pelvic assessment were recruited. They underwent transabdominal ultrasound (TAS) for evaluating head position and head circumference, and TPU for evaluating head station with and without applying fundal pressure, various cervical parameters, sub pubic angle. Equivalent five USG parameters were scored along similar lines as the Bishop score. These women underwent vaginal examination for Bishop score and pelvic adequacy by an obstetrician who was blinded about USG parameters. While spontaneous onset of labour (SOL) was awaited in some of these women, some were induced as and when indicated. After delivery, the Bishop scores, pregnancy outcome in terms of SOL or induction of labour (IOL), mode of delivery and duration of labour were noted retrospectively from case records. Independent predictors of caesarean were obtained by univariate and multivariate analysis. Results: All the parameters were assessed for predictive ability of caesarean section by univariate analysis. The cervical length, angle of progression (AOP) at rest, head perineal distance (HPD) at rest and with pressure, Bishop score and USG score were found significant. On multivariate analysis, cervix length and USG score were found to be statistically significant. At a USG score of ≤ 5, the sensitivity and specificity to predict caesarean section were 84% and 68%, respectively. The relative risk (RR) was 4.9 (95% CI 2.3–12). The USG score could predict SOL. The p value was 0.001. The area under the curve (AUC) for the ultrasound score was 0.74. Conclusions: USG examination by USG score at term gestation before the onset of labour can predict mode of delivery by caesarean section. It can predict spontaneous onset of labour. However, among all the individual parameters, cervix length has best predictive ability for caesarean section. [ABSTRACT FROM AUTHOR]

Background and Aims Transabdominal ultrasonography [TAUS] appears comparable to colonoscopy for evaluating ulcerative colitis [UC] activity, but it has low accuracy in rectal evaluation. In this study, the accuracy of transperineal ultrasonography [TPUS] for evaluating rectal activity was compared to that of colonoscopy in paediatric UC cases. Methods Faecal calprotectin [FCP] values and TPUS and colonoscopic findings were compared prospectively in paediatric UC cases. Rectal wall thickening [RWT] and rectal wall flow [RWF] on power Doppler evaluated by TPUS were compared with the colonoscopy findings and were also measured on TAUS and assessed for the concordance rate of each finding. Results Thirty Mayo endoscopic sub-score [MES] 0–1 UC cases and 57 MES 2–3 UC cases were enrolled. FCP, RWT and RWF showed significant differences between the two groups [ p  < 0.05]. RWT and RWF were independent predictors of UC endoscopic activity, showing sensitivity of 95.8% and specificity of 100% with RWT ≥ 4.5 mm and positive RWF. The concordance rates between TPUS and TAUS findings in MES 2–3 were moderate to fair, whereas those in MES 0–1 were fair to poor. The concordance rates between ultrasonic examiners were good for both TAUS and TPUS. Conclusions TPUS may evaluate rectal activity of UC with accuracy comparable to endoscopy. If accurate ultrasonic screening for the total colon can be performed by TPUS and TAUS, repeated evaluation of short-term treatment response may be possible. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate the anatomical changes in the pelvic floor of women with breast cancer using tamoxifen by transperineal 3D ultrasonography and their effect on the urinary incontinence and sexual dysfunction. Methods: Ninety-four patients with breast cancer using TAM in the study group and ninety-five healthy women of the same age in the control group were included in this prospective cohort study. Female Sexual Function Index and Incontinence Questionnaire-Short Form scales were applied to both groups. Ultrasonographic evaluation was performed at resting and Valsalva Maneuver with a convex (3–8 MHz) probe transperineally and the levator urethra gap and levator hiatus diameter were measured after 3-dimensional imaging. Independent t-tests were performed for statistical analysis. Results: The mean age and body mass index of the experimental group versus control groups were 46.3 ± 6.12 years versus 46.4 ± 5.23 years and 27.6 ± 4.34 kg/m2 versus 29.2 ± 6.45 kg/m2, respectively. LUG and LH values were found significantly higher for the experimental groups compared to control groups at 17.23 ± 2.53 mm versus 14.1 ± 2.23 mm and 21 ± 2.45 cm2 versus 18 ± 4.56 cm2, respectively. (p < 0.05). The FSFI score significantly decreased (12.49 ± 3.58 versus 20.89 ± 3.69) and the ICIQ-SF score increased (4.02 ± 0.34 versus 2.34 ± 0.45) in the experimental group in comparison to control group (p < 0.05). Conclusion: This study demonstrated that the effects of TAM usage on pelvic floor can be detected by measuring the changes in the levator ani muscle using the transperineal 3D USG. With transperineal USG screening, pelvic floor changes can be early diagnosed and clinical measures can be taken before they become symptomatic. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: The clitoris has a critical pivotal role in female orgasm and arousal. The aim of this cross-sectional study was to evaluate topographic measurements of the clitoris, as well as to explore potential relationships between the clitoral complex and the orgasm domain of female sexual function, combining transperineal ultrasound with morphometric measurements. Methods: In sexually active, heterosexual, premenopausal women, three-dimensional transperineal ultrasound imaging was used to measure the subpubic angle, the anterior triangle area (ATA) of the genital hiatus, the levator urethra gap, and the anteroposterior and transverse diameters of the genital hiatus. Mons pubis thickness, clitoris–urethra distance (CUD), clitoris–fourchette distance, and fourchette–perineal body distance were measured using a caliper. Comparison of measurements and correlation with orgasm score were performed. Results: Among the 108 sexually active women, 30 (27.7 %) reported a low orgasm domain score. There were statistically significant differences between the low orgasm group and the control group in the ATA (4.05 vs 3.64 cm2 respectively; p = 0.03), CUD (21 mm; p = 0.04 vs 16.1 mm; p = 0.04), and volume of the glans clitoris (947.7 mm3 vs 1081 mm3; p = 0.02). There was a moderate and inverse correlation between clitoris–urethra distance and orgasm (r = −0.53, p < 0.001), and arousal (r = −0.42 p < 0.001). Broader ATA (OR = 0.47; 95 % CI = 0.23–0.99; p = 0.04) and longer CUD (OR = 0.57; 95 % CI = 0.44–0.73; p < 0.001) were identified as the only independent predictors of orgasm problems. Conclusions: Longer glans clitoris–urethra distance and broad space for the deep structures of the clitoris is related to difficulty in reaching orgasm and arousal problems. [ABSTRACT FROM AUTHOR]

Background: Pelvic floor dysfunctions (PFDs) are commonly encountered in pregnancy, which may include urinary and fecal incontinence, pelvic pain, sexual dysfunction and pelvic organ prolapse. Identifying these problems and their risk factors in pregnancy is crucial for prevention and management. The primary outcome of this study is to investigate the relationship between the PFD symptoms in pregnant women and perineal ultrasonography measurements. Secondary outcomes are to figure out the risk factors for PFDs in pregnancy and also to identify the relationship between these risk factors with transperineal ultrasonography measurements and pelvic floor muscle strength (PFMS). Methods: 49 pregnant women recruited in the study, were asked to fill questionnaires, underwent transperineal ultrasonography and pelvic floor muscle strength examination. Results: The hiatal area at rest, pelvic contraction and Valsalva are positively correlated with stress urinary incontinence (SUI) (p = 0.018, p = 0.003 and p = 0.006 respectively), pelvic organ prolapse (POP) (p = 0.015, p = 0.022 and p = 0.011 respectively) and sexual dysfunction (SD) (p = 0.033, p = 0.041 and p = 0.023 respectively). Hiatal area at Valsalva and detrusor muscle thickness are positively correlated with urge urinary incontinence (UUI) (p = 0.021 and p = 0.012). The hiatal area value at pelvic contraction and Valsalva are positively correlated with feacal/flatal incontinence (FFI) (p = 0.024 and p = 0.037). Hiatal areas at rest, pelvic contraction, Valsalva and detrussor muscle thickness are correleated with age (r = 0.287, r = 0.335, r = 0.315 and r = 0.421 respectively), body mass index (r = 0.380, r = 0.420, r = 0.415 and r = 0.447 respectively) and pelvic floor muscle strength (r = –0.539, r = –0.583, r = –0.550 and r = –0.545 respectively). Bladder neck descent is correlated with body mass index (r = 0.284). Conclusions: Transperineal ultrasound measurements of Detrusor muscle thickness, hiatal area (HA) at rest, pelvic contraction and Valsalva Manoeuvre are found to be associated with PFDs in pregnant women. Risk factors for PFDs in pregnancy are body mass index, age, gestational week, parity, birth weight and delivery method.

Background: Transabdominal ultrasonography and transperineal ultrasonography (TPUS) appear correspond to colonoscopy (CS) for evaluating ulcerative colitis (UC) activity, but their utility in UC diagnosis remains unclear. This research compared the accuracy of TPUS and CS for assessing rectal activity and differentiating noninflammatory bowel disease proctitis from UC in pediatric cases., Methods: The study is a blinded, prospective, and controlled trial. Prospectively, values of fecal calprotectin (FCP) and findings of the TPUS and CS were compared between child cases of UC and non-IBD proctitis. Findings of rectal wall thickening (RWT), rectal wall flow (RWF) on power Doppler, and microvascular signal at wall circumference (MSWC) on monochrome superb microvascular imaging assessed using TPUS were compared with the CS., Results: Thirty patients with Mayo endoscopic subscore (MES) 0 to 1 UC, 57 with MES 2 to 3 UC, and 44 with proctitis were registered. Fecal calprotectin, RWF, and MSWC indicated significant differences among the groups (P < .05). Rectal wall thickening showed no significant difference between MES 0-1 and proctitis (P = .76). Rectal wall thickening and MSWC were independent predictors of endoscopic activity of UC, resulting in a sensitivity and specificity of 100% for RWT ≥4.5 mm and positive MSWC. Fecal calprotectin and RWF were independent predictors for differentiating MES 0 to 1 and proctitis, and FCP and RWT were independent predictors for differentiating MES 2 to 3 and proctitis. Sensitivity and specificity were 77.2% and 80.9%, respectively, for FCP >242.5 μg/g and RWF negative; and they were both 100% for RWT >4.1 mm and MSWC positive., Conclusions: Transperineal ultrasonography with mSMI may enable the evaluation of rectal activity and differentiation of UC from non-IBD proctitis with accuracy comparable to endoscopy., (© The Author(s) 2023. Published by Oxford University Press on behalf of Crohn’s & Colitis Foundation. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)