Use of 3D Ultrasound as a New approach to Assess Obstetrical Trauma to the Pelvic Floor

Objective. To determine whether 3D ultrasound examination of pelvic floor anatomy after vaginal delivery allows detection of childbirth trauma. Study Design: Pelvic floor anatomy was examined in 16 women during the puerperium with a 3D transrectal ultrasound probe. Images were acquired via the vaginal route for the assessment of anal morphology and the transrectal route to determine paravaginal fixation. Images of the anterior pelvic floor were calculated from the information stored in the volume block. Paravaginal defect is defined as a descent of the lateral vaginal wall below the suburethral vagina, whereas sphincter defects are characterised as thinning, or as gap formation of the anterior part of the internal anal sphincter. Results: This new approach allowed the examination of a horizontal plane through the urethra and the periurethral tissue which is inaccessable with 2D ultrasound techniques. Morphology of the normal and traumatised anal sphincter could be demonstrated using reference planes perpendicular to the anal canal. Conclusions: Whereas in the past, defects of the vaginal attachment to the pelvic side wall could not be examined sonographically, 3D ultrasound can now be used to examine pelvic floor anatomy and to detect changes associated with trauma to the pelvic floor following vaginal delivery.