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Is 2D-ultrasound a reliable method for measurement of pelvic floor muscle contraction?
IUGA Academy. Nyhus M. Jun 30, 2018; 212869
Maria Nyhus
Maria Nyhus

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498

Is 2D-ultrasound a reliable method for measurement of pelvic floor muscle contraction?

Nyhus, M1; Salvesen, K2; Volløyhaug, I1

1: NTNU; 2: St Olavs hospital, Trondheim, Norway

Introduction: The levator ani muscle surrounds the urethra, vagina and rectum, and provides resting tone and contraction of the pelvic floor, giving a narrow closure of the urogenital hiatus that prevents pelvic organ prolapse (POP). Pelvic floor exercise is effective for prevention and treatment of urinary incontinence (UI) and POP. Different tools can be used to investigate pelvic floor muscle contraction: digital palpation, perineometry and surface-electromusculographi (sEMG). All methods have disadvantages, and no gold standard exists. 3D/4D-transperineal ultrasound has become a method for evaluation of pelvic floor contraction.(1, 2) 2D-ultrasound is easier and less time-consuming, but has not been studied properly as a measure of pelvic floor contraction.

Objective: Our objective was to determine the interrater correlation for 2D- and 3D-ultrasound measures of pelvic floor contraction, and to study any correlation between ultrasound, Modified Oxford Scale (MOS)-evaluated palpation, perineometry and sEMG for assessment of contraction in women with pelvic floor disorders and in pregnancy.

Methods: This was a cross-sectional study of 60 women scheduled for stress UI-surgery (n=29), POP-surgery (n=15) and primigravida (n=16). They were examined with MOS-evaluated palpation, perineometry, vaginal sEMG and transperineal ultrasound. Two independent raters analyzed ultrasound volumes offline. Hiatal area and anteroposterior (AP) diameter were measured in a rendered 3D-volume in the plane of minimal hiatal dimensions, in addition, the AP-diameter was measured in the mid-sagittal plane (2D). We used proportional change between rest and contraction ((measurementrest-meaurementcontraction/measurementrest) x100) as measure of contraction. Intraclass correlation (ICC) was used to determine level of agreement between the raters. We used Spearman´s rank to correlate ultrasound measurements with MOS, perineometry and sEMG.

Results: Table 1 shows mean values for ultrasound measurements and ICC between rater I and II. Table 2 outlines the correlation (rs) between ultrasound and MOS, perineometry and sEMG.

Conclusions: Ultrasound seems to be an objective and reliable method for evaluation of pelvic floor contraction with good ICC, and the best ICC was found for % change in 2D AP-diameter. 2D-ultrasound is easily available and a low-cost examination with minimal discomfort for the women. The correlation between MOS, perineometry, sEMG and ultrasound was weak to moderate, probably caused by subjective bias in palpation and false high values induced by co-activation of other muscle groups in perineometry and sEMG. These biases are eliminated by ultrasound, and after validation in larger populations, % change in 2D AP-diameter could be used as a new, more objective gold standard for evaluation of pelvic floor muscle contraction.

% change in ultrasound

measures

Rater

Mean

SD

ICC

95%CI

2D-AP

I

20.8

8.6

0.86

0.76, 0.92

II

21.3

8.7

3D-AP

I

19.8

9.3

0.79

0.65, 0.88

II

20.4

10.3

3D-area

I

26.2

11.5

0.77

0.61, 0.87

II

26.0

12.5

Table 1

Table 2

% change in ultrasound

measures

MOS

Perineometry

sEMG

rs

p

rs

p

rs

p

2D-AP

0.38

0.003

0.43

0.001

0.34

0.007

3D-AP

0.63

< 0.001

0.58

<0.001

0.48

<0.001

3D-area

0.45

< 0.001

0.36

0.006

0.33

0.011

References:

  1. Int Urogynecol J. 2016;27(1):39-45.
  2. Ultrasound Obstet Gynecol 2015;45(2):217-22.

Disclosure:

Work supported by industry: no.

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