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Objective:To assess the urethral mobility of normal parous women in China and explore the impacts of related risk factors on it using translabial ultrasound.Methods:Females who met the inclusion criteria in 37 tertiary hospitals from February 2017 to August 2018 were included. All women underwent standardized translabial ultrasound examination and the urethral rotation angle (URA), bladder neck position at maximum Valsalva maneuver (BNP-V) and bladder neck descent (BND) were measured. Questionnaires were used to collect basic information including age, height, weight, body mass index (BMI), past medical history, maternity history, and urinary incontinence related history. Mann-Whitney U test and multiple linear regression analysis were adopted to explore the influences of age, BMI, delivery mode and parity on normal parous women′s urethral mobility. Then, the study subjects were divided into different groups and the corresponding values of URA, BNP-V and BND were compared. Results:Compared with parous women with normal BMI and no history of vaginal delivery, those who were overweight and/or had a history of vaginal delivery were more likely to gain greater URA and BND ( P<0.05). The URA and BND were not significantly different between women with different times of cesarean sections ( P>0.05); while for women with a history of vaginal delivery, these two parameters increased with the increase of the number of transvaginal deliveries ( P<0.05). Conclusions:BMI and vaginal delivery are important risk factors for the urethral mobility of normal parous women. The urethral mobility increases with the increase of BMI and the number of vaginal deliveries.
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Objective To explore the feasibility of intelligent spatiotemporal image correlation-fetal heart navigator(iSTIC-FHN) in the display of the ductal arch view in normal fetuses ,and to compare two-dimensional echocardiography( 2DE) and iSTIC-FHN based measures of ductus arteriosus( DA ) in normal fetuses . Methods Two hundred and eleven normal fetuses with gestational age of 22 - 32 weeks were enrolled . Each fetus had undergone conventional 2DE examination and the iSTIC fetal cardiac volumes were obtained .The volume datasets were analyzed offline using new automatic software ( the Fetal Heart Navigator ,FHN ) . The diameter of DA were measured by 2DE and iSTIC based FHN ,respectively . Pearson's correlation analysis was used to examine the relation between gestational age and diameter of DA for both 2DE and iSTIC-FHN . The measurement of the diameters of ductus arteriosus by two methods were compared . Results The ductal arch view using FHN was successfully obtained in 165(78 .2％ ) cases among 211 normal cases . The comparison of 2DE and iSTIC-FHN in the measurement of the DA was made in 131(62 .1％ ) normal fetuses . Mean 2DE DA increased from ( 3 .00 ± 0 .23) mm at 22 weeks to ( 5 .42 ± 0 .26) mm at 32 weeks . Mean iSTIC-FHN DA increased from ( 2 .96 ± 0 .21) mm at 22 weeks to ( 5 .36 ± 0 .17) mm at 32 weeks . There was a good correlation between the two methods ( Pearson's R 2 = 0 .942 ,P =0 .539) . Bland-Altman plot showed the 95％ limits of agreement was ( - 0 .3287 ,0 .3111) . Conclusions iSTIC-FHN is the potential tool for the evaluation of the ductal arch view .
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Objective To observe the near-term impact of the second natural delivery on the structure of a female pelvic floor by ultrasonography. Methods Selected fifty second-natural-delivery women and fifty first-natural-delivery women from Tongde Hospital of Zhejiang Province between October, 2016 and October, 2017 undertook pelvic ultrasonnography (42 days postpartum). Pelvic ultrasonography was used to determine all mothers' bladder neck descent, bladder posterior angle, bladder neck tilt angle, bladder neck rotation angle, and the area of pelvic diaphragm hiatus when performing the Valsalva maneuver. Besides, pelvic ultrasonography was used to determine the extent of mothers' internal-urethral-of-orifice funneling, perineal hyperactivity, uterine prolapse and rectal bulge. The paired t test was applied between groups to compare the bladder neck descent, bladder posterior angle, bladder neck tilt angle, bladder neck rotation angle and the area of pelvic diaphragm hiatus of the second-natural-delivery mothers with those of the first-natural- delivery mothers. The χ2test was also applied to examine the degree of mothers' uterine prolapse, rectal bulge and internal-urethral-of-orifice funneling, as well as their perineal hyperactivity rate. Results The bladder neck descent, bladder posterior angle, bladder neck tilt angle, bladder neck rotation angle and the area of pelvic diaphragm hiatus of the second-natural-delivery mothers were all wider than those of the first-natural-delivery mothers [(29.37±5.32) mm vs (22.63±6.35) mm, (148.8±14.97)° vs (141.2±15.20)°, (73.69±16.03)° vs (69.8±15.25)°, (44.41±19.27)° vs (40.0±17.52)°, (21.47±5.19) cm2vs (19.15±4.10) cm2], and differences were statistically significant (t=5.761, P ＜0.001; t=2.519, P=0.001; t=2.476, P=0.001;t=3.123, P=0.001; t=2.481, P＜0.001). The degree of the second-natural-delivery mothers'uterine prolapse and internal-urethral-of-orifice funneling as well as their perineal hyperactivity rate were all higher than those of the first-natural-delivery mothers [46.0% (23/50) vs 20.0% (10/50), 12.0% (6/50) vs 6.0% (3/50), 20.0% (10/50) vs 6.0% (3/50)], and differences were statistically significant ( χ2=7.644, P=0.006; χ2=3.342, P=0.043; χ2=4.332, P=0.037). The differences in the incidence rate of rectal bulge between the two groups were of no statistical significance [4.0% (2/50) vs 2.0% (1/50), χ2=1.197, P=1.000]. Conclusions The pelvic ultrasonogram showed that the near-term impacts of the second natural-delivery on women's pelvic floor were more obvious than those of the first natural delivery. What's more, pelvic floor ultrasound has been proved to be a reliable basis for the diagnosis and screening of dysfunctional diseases of pelvic floor.
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Objectives To develop Z-scores reference ranges for kidney in normal fetuses from the measurements of gestational age (GA),biparietal diameter (BPD) or femur length (FL) using two-dimension ultrasound.Methods A retrospective cross-sectional study of 403 singleton normal fetuses was performed.The gestation age range was from 18 to 40 weeks.Fetal biologic parameters included GA and BPD and FL based on menstrual age.Left kidney length and left kidney width of normal fetus were measured.Normal Z-score ranges were developed for leftkidney length or left kidney width using GA,BPD and FL as independent variables.Results Linear regression model was the best description of the data in each case and correlation between left kidney length or left kidney width and independent variables were excellent (r=0.8761,0.8818,0.8797,0.8604,0.8723,0.8643).All P values were less than 0.01.The equations were as follows,Y=0.094 22 + 0.1088X,Y=0.132 57 + 0.4349X,Y=0.6664 + 0.491 05X,Y=0.060 58X-0.051 98,Y=0.262 19X-0.197 55,Y=0.294 02X + 0.136 19.Heteroscedasticity of standard deviation (s) with increasing independent variables also could be modeled with a simple linear (r=0.925,0.934,0.915,0.908,0.914,0.922),All P values were less than 0.01.The equations were as follows,Y=0.025 + 0.005 58X,Y=0.097 09 + 0.010 45X,Y=0.046 17 + 0.025 65X,Y=0.001 13 + 0.002 24X,Y=0.003 67 + 0.011 55X,Y=0.005 07 + 0.015 89X.Then we got Z-scores based on the equation,Z-score=(actual measurement data of left kidney length or left kidney width-predictive data of left kidney length or left kidney width) predictive s.Conclusions Normal reference ranges and Z-scores for fetal left kidney length and left kidney width had been provided.These normative data may be useful tools for assessment of fetal kidney length and kidney width,especially had potential applications in malformations of fetal kidney.
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Objective To evaluate the concordance of two-dimensional echocardiography (2DE) and intelligent spatiotemporal image correlation (iSTIC) in measuring fetal aortic and aortic arch diameters during the second and third trimesters.Methods Data were collected by a prospective cross-sectional study of 140 normal singleton fetuses with the gestational age from 22 to 32 weeks.A total of 6 dimensions of the fetal aortic and aortic arch,including aortic annular diameter (AO),ascending aorta diameter (AAO),aortic arch diameter [AO Arch (INA to LCCA)],aortic arch diameter [AO Arch (LCCA to LSA)],aortic isthmus diameter and descending aorta diameter (DAO),were measured by two different methods.Concordance was assessed by comparing the measurements acquired by iSTIC with those determined by 2DE and depicted by Bland-Altman plots.Inter-and intra-observer variability was evaluated by the intraclass correlation coefficient (ICC) test.Results A total of 137 iSTIC volumes in 140 cases were found to be suitable for further analysis.Good correlation was observed in the measurements that determined by 2D or iSTIC (Pearson's R2 =0.977-0.983).There was no significant difference in the mean values of all the parameters that measured by two methods.Bland-Altman plot showed that the 95％ limits of agreement (LOA) in AO,AAO,AO Arch (INA to LCCA),AO Arch (LCCA to LSA),aortic isthmus diameter and DAO were (-0.1260/+ 0.2299),(-0.1707/+ 0.2241),(-0.1547/+ 0.2190),(-0.1736/+ 0.2024),(-0.1514/+ 0.2039) and (-0.1485/+ 0.2228),respectively.The points in the outside of LOA were 5.11％ (7/137),4.38％ (6/137),5.11％ (7/137),5.84％ (8/137),4.38％ (6/137)and 4.38％ (6/137),respectively.Conclusions iSTIC has a good agreement with 2DE in measuring fetal aortic and aortic arch dimensions during the second and third trimesters.
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Objective To develop Z-score reference ranges for mitral valve-tricuspid valve distance (MTD) in normal fetuses from the measurements of femur length (FL),biparietal diameter (BPD) or gestational age (GA) using fetal echocardiography.Methods A retrospective cross-sectional study of 1216singleton normal fetuses was performed.The gestation age ranged from 20 to 40 weeks.Non-cardiac fetal biometric parameters included FL and BPD and GA based on menstrual age.MTD was measured in a standard apical four-chamber view.Normal Z-score ranges were developed for MTD using GA,BPD and FL as independent variables.These were accomplished by using first standard regression analysis and then weighted regression of absolute residual values for each parameter in order to adjust for inconstant variance.Results Linear regression model was the best description of the data in each case and correlations between MTD and independent variables (FL,BPD,GA) were excellent.The linear regression equations between MTD and FL,BPD,GA were:Y =0.04629 × FL-0.02868 (r =0.827) ; Y =0.04018 × BPD-0.08293(r =0.767) ; Y =0.0098 × GA-0.07075 (r =0.721),respectively.Heteroscedasticity of standard deviation(SD) with increasing independent variables also could be modeled with a simple linear regression.Linear regression equations between SD of MTD and FL,BPD,GA were:Y =0.0149 × FL-0.0095 (r =0.9947),Y =0.0126 × BPD-0.02793 (r =0.9931),Y =0.00305 × GA-0.021 (r =0.991),respectively.According to these equations,MTD Z-score =(the actual measurement of MTD-predicted MTD)/prediction SD.Conclusions Normal reference ranges and Z-scores for MTD have been provided.These normative data may be useful tools for assessment of fetal MTD,especially has potential applications in Ebstein anomaly or other malformations involved atrioventricular valves.