The value of pelvic floor ultrasound measurement of the distance between the levator ani muscle and pubic symphysis in predicting early postpartum pelvic organ prolapse
Objective To explore the value of pelvic floor ultrasound measurement of the distance between the pubic symphysis and the levator ani muscle in predicting early postpartum pelvic organ prolapse(POP).Methods 221 postpartum women who underwent pelvic floor ultrasound examination in the ultrasound department of our hospital at 6-8 weeks postpartum were selected as the research subjects.All women underwent two-dimensional and three-dimensional pelvic floor ultrasound examination,and the anal pubic distance was measured in the resting state,maximum valsalva state,and anal contraction state,respectively.The distance between the bladder,uterus,rectum,and the posterior lower edge of the pubic symphysis was measured,and the relationship between the anal pubic distance and POP under different states was analyzed.The receiver operating characteristic(ROC)curves of the anal pubic distance in the resting state and valsalva state were plotted to predict POP.Results Among 221 parturients,150 had POP,accounting for 67.9％(150/221),57 had two or more types of POP,71 had no obvious POP:132 of them had cystocele(80 mild cases,52 obvious cases),accounting for 59.7％(132/221),and 56 had infundibulation of internal urethral opening.There were 44 cases of uterine prolapse(mild 43 cases,obvious 1 case),accounting for 19.9％(44/221).There were 38 cases of proctocele(35 mild cases,3 obvious cases),accounting for 17.2％(38/221).The spacing between the anal and pubic areas in 221 cases at rest ranged from 32 to 65 mm,with an average of(48.8±7.3)mm.In the maximum Valsalva state,the anopubic distance shifted to the dorsal side of the foot,and the anopubic distance increased,ranging from 40 to 85 mm,with an average of(61.2±8.0)mm.In the condition of retraction,the spacing between the anopubic and the anal was shifted to the ventral side of the head,and the spacing between the anopubic and the anal became smaller,ranging from 27 to 54 mm,with an average of(40.2±5.2)mm.The anal pubic distance in POP group was higher than that in no POP group at resting state,maximum Valsalva state and anal retraction state(P＜0.05).The anopubic distance at rest and maximum Valsalva in the group with cystocele was greater than that in the group without cystocele(P＜0.05).The maximum Valsalva distance between the anopubic area and the anal area in the prolapse group and the proctocele group was greater than that in the non-prolapse group and the non-proctocele group(P＜0.05).The ROC of POP predicted by anopubic distance at resting state and maximum Valsalva state was plotted.AUC at resting state and maximum Valsalva state were 0.657 and 0.784,95％CI was 0.578～0.735 and 0.725～0.844,respectively.The optimal cut-off values were 45.5mm and 62.5mm,the sensitivity were 77.3％and 56.0％,and the specificity was 49.3％and 85.9％.Conclusion Pelvic floor ultrasound measurement of anal pubic distance is simple and convenient,and can effectively predict early postpartum POP,with significant clinical application value.
Pelvic floor ultrasound examinationPelvic organ prolapseThe distance between the pubic symphysis of the levator muscle and the pubic symphysis
NETL
NSTL
万方数据
维普
