Revisión bibliográfica: ecografía intraparto / Review: intrapartum ultrasound

The evaluation of labor is the clinical process by which variables are analyzed in order to determine whether the patient is in labor, which by definition includes regular uterine contractions that increase in frequency and intensity, associated with dilation cervical. This is done through the anamnesis and physical examination, specifically through the evaluation of contractions and vaginal examination, the latter is intended to specify the degree of dilation, cervical effacement that the patient presents and also allows to a certain degree, establish the presentation, attitude and variety of position in which the fetus is located. From this premise, it is proposed that vaginal examination, since it is operator dependent, is not an objective evaluation, therefore, there is a need to reach consensus on the evaluation, and in order to carry it out, evaluation with ultrasound is proposed, which has as a purpose to objectify the variety of position and presentation of the fetus. Due to the above, this article aims to capture the knowledge that is currently possessed about the uses and methodology that intrapartum ultrasound presents.

Value of Transperineal Ultrasound in Short-term Evaluation of Pelvic Organ Prolapse after Transvaginal Mesh Implantation / 中国医学科学院学报

Objective To observe the patients after transvaginal mesh(TVM)implantation surgery by using transperineal ultrasound(TPUS),compare the diagnosis of pelvic organ prolapse(POP)by TPUS and clinical examination[according to the Pelvic Organ Prolapse Quantification(POP-Q)system published by the International Continence Society],and to explore the role of ultrasound in postoperative evaluation as well as the high-risk factors of post-surgery POP recurrence. Methods This is a retrospective study based on the POP-Q records and TPUS data sets of patients within 6 months after TVM surgery during September 2013 and November 2019.The diagnostic results of TPUS and POP-Q were compared.The incidences of hiatal ballooning and levator avulsion were separately compared between the TPUS group and the control group. Results A total of 147 patients were enrolled.The Kappa values between TPUS and POP-Q in the diagnosis of anterior and posterior compartment POP were 0.268(

Evaluating intra-fractional prostate motion in radiotherapy of prostate cancer with four-dimensional real-time transperineal ultrasound / 西安交通大学学报(医学版)

Objective: To evaluate intra-fractional prostate motion by applying four-dimensional real-time transperineal ultrasound (TPUS) so as to provide reference evidence for the moderate hypofrectionation radiotherapy for prostate cancer. Methods: Ten patients with prostate cancer were randomly selected to be treated with volume modulated radiotherapy (VMAT). TPUS was utilized to collect 60 intra-fraction data. Prior to each treatment for all the patients, CBCT was adopted to correct inter-fraction setup errors. During treatment, four-dimensional real-time ultrasound images were acquired to monitor the 3D prostate motion. Results: Among all the data, the maximum distance of prostate motion was 1.85 mm in the left direction, 0.50 mm in the right direction, 1.83 mm in the anterior direction, 3.04 mm in the posterior direction, 2.68 mm in the cranial direction, and 1.75 mm in the caudal direction. The percentage of fractions in which the distance of prostate motion was more than 2 mm among all treatment fractions was 3% in the left and right (LR) direction, 11% in the anterior and posterior (AP) direction, and 5% in the cranial and caudal (CC) direction. The distance was greater in AP direction than in AP direction and CC direction. Results: TUPS is a non-invasive and reliable technique which can detect the real-time motion of the prostate during radiotherapy aiming to prevent tumor target areas from being missed or normal tissues from being overexposed.

Magnetic resonance imaging and 3-dimensional transperineal ultrasound evaluation of pelvic floor dysfunction in symptomatic women: a prospective comparative study

PURPOSE: The purpose of this study was to investigate magnetic resonance imaging (MRI) and 3-dimensional transperineal ultrasound (3D-TPUS) features of pelvic floor dysfunction (PFD) in symptomatic women in correlation with digital palpation and to define cut-offs for hiatal dimensions predictive of muscle dysfunction. METHODS: This prospective study included 73 women with symptoms suggesting PFD. 3D-TPUS, MRI, and digital palpation of the levator ani muscle were performed in all patients. Levator hiatal antero-posterior (LHap) diameter and area (LH area) were measured at rest and at maximum muscle contraction. RESULTS: The reduction in LHap diameter and LH area during contraction was significantly less in women with underactive pelvic floor muscle contraction (UpfmC) than in those who had normal pelvic floor muscle contraction by digital palpation (P<0.001). Statistically significant positive correlations (P<0.001) were found between the Modified Oxford Score and 3D-TPUS and MRI regarding the reduction in the LHap diameter (r=0.80 and r=0.82, respectively) and LH area (r=0.60 and r=0.70, respectively). A reduction in LHap of <6.5% on 3D-TPUS and <7.6% on MRI predicted UpfmC with sensitivities of 46.2% and 82.7%, respectively. A reduction in LH area of <3.4% on 3D-TPUS and <3.8% on MRI predicted UpfmC with sensitivities of 75.0% and 88.5%, respectively. MRI was more sensitive in detecting levator avulsion (63.4%) than 3D-TPUS (27.1%). CONCLUSION: MRI and 3D-TPUS had strong positive correlations with findings on palpation, and at certain cut-offs for hiatal dimensions, they can be used as complementary and objective tools to improve the accuracy of diagnosis and management planning of PFD.

Measurement of retropubic tissue thickness using intrapartum transperineal ultrasound to assess cephalopelvic disproportion

PURPOSE: First, to describe a new method of assessing cephalopelvic disproportion by measuring the retropubic tissue thickness (RTT), and second, to determine whether RTT was associated with an eventual delivery by cesarean section. METHODS: Three-dimensional transperineal ultrasound scans were performed on 129 laboring nulliparous women to obtain 3-dimensional volume datasets for assessing RTT. RTT was measured off-line by three operators (A, B, and C) as the shortest distance between the capsule of the pubic symphysis and the outer border of the fetal skull. The intraoperator repeatability of operator A and the interoperator reproducibility among A, B, and C were determined. The RTT in women who were delivered by cesarean section due to failure to progress was compared to that of women who had a vaginal delivery. RESULTS: The intraoperator repeatability for RTT was 1.2 mm. The overall RTT interoperator interclass correlation was 0.97 (0.95-0.98). The RTT in women who had a spontaneous, instrumental, or cesarean delivery was 1.16±0.32 cm, 1.12±0.25 cm, and 0.94±0.25 cm, respectively. Women who were delivered by cesarean section had a significantly smaller RTT than women who had a spontaneous delivery (P=0.008). There was no statistically significant difference in RTT between patients who had a normal vaginal delivery and patients who had an instrumental delivery (P=0.990), or between those who had an instrumental delivery and those who had a cesarean delivery after the Bonferroni correction (P=0.120). CONCLUSION: RTT can be measured with satisfactory intraoperator repeatability and interoperator reproducibility. RTT was significantly smaller in women who eventually had a cesarean delivery than in those who had a vaginal delivery.

Application of real-time transperineal ultrasound in radiotherapy of prostate cancer-4D analysis of intra-fractional prostate motion / 中华放射肿瘤学杂志

Objective To apply real-time transperineal ultrasound ( TPUS) to monitor the intra-fractional prostate motion,collect and analyze the data of the prostate motion,aiming to provide evidence for the optimization of the target area and plan of radiotherapy for prostate cancer. Methods TPUS is a non-invasive monitoring technique that utilizes an automatic scanning ultrasound probe to dynamically monitor and correct the motion of organs during radiotherapy. In this study, TPUS was utilized to collect 1588 intra-fractional data of 70 patients with prostate cancer. Prior to each cycle of radiotherapy,CBCT was adopted to correct the errors between intra-factional data by using VMAT. During radiotherapy, real-time ( once per second) ultrasound images were acquired to monitor the 3D motion of the prostate on the x (left+,right-),y (cranial+, caudal-), and z ( abdominal+, dorsal-) axes, emphasizing the analysis of 4D motion of the prostate. Results All patients successfully completed the treatment and data collection. The median time of effective monitoring per faction was 179 seconds (132-286 seconds). During 95% of the monitoring time,the distance of prostate motion was 2. 22 mm in the left direction,2. 17 mm in the right,2. 08 mm in the cranial, 1. 98 mm in the caudal,2. 44 mm in the abdominal and 2. 97 mm in the dorsal direction,respectively. In the x,y and z axes,the percentage of time in which the distance of prostate motion less than 1 mm among the total time was 83. 07%,85. 46% and 78. 27%,respectively,whereas 97. 70%,97. 87% and 96. 45% for＜3 mm, respectively. Conclusions TPUS is a non-invasive real-time monitoring technique,which can detect the 4D motion of the prostate during radiotherapy. By using VMAT,the range of prostate motion is relatively small, and the motion range is less than 3 mm in each direction within 95% of the time.

Determining "abnormal" levator hiatus distensibility using three-dimensional transperineal ultrasound in Chinese women / 医学前沿

The dimension of the levator hiatus is a possible predictor of pelvic organ prolapse (POP). This retrospective study investigated 360 women who went to urogynecological clinic for pelvic floor discomfort. Levator hiatus dimensions were obtained by three-dimensional transperineal ultrasound and results were compared between women with and without significantly objective prolapse (International Continence Society POP quantification, grade 2 or higher). Receiver operating characteristic (ROC) curve analyses were performed to determine valid screening index for detecting abnormal levator hiatus distensibility. Women with significantly objective prolapse had significantly higher levator hiatus dimensions than those without (all P < 0.001). ROC curve analyses confirmed that hiatal area (HA) of 19.5 cm during Valsalva maneuver can be used as single-screening index for abnormal levator hiatus distensibility with sensitivity of 0.80 and specificity of 0.70. In this study, we used a two-step method and achieved higher sensibility (0.80 vs. 0.87) without reducing specificity (0.70 vs. 0.71) compared with a single-screening index method. As a result, we suggest that HA ⩾ 19.5 cm during Valsalva maneuver is an indicator of abnormal levator hiatus distensibility in Chinese women and that the two-step method has higher sensitivity in detecting abnormal distensibility.

The Observation in Pelvic Floor by the Transperineal Ultrasound in Patients with Stress Urinary Incontinence in Late Pregnancy and ROC Curve Analysis / 中国医科大学学报

Objective To investigate the clinical diagnostic value of transperineal ultrasound in women in late pregnancy with stress urinary inconti?nence. Method Totally 66 cases of women in late pregnancy were selected,who did not suffer from SUI(groupⅠ),and 54 cases of women in late pregnancy who suffered from SUI(groupⅡ). Another 63 cases of healthy childless women were used as normal control(groupⅢ). Transperineal ultrasound was used to dynamically observe their pelvic floor structure,and the ultrasonic parameters were recorded and analyzed,including the posi?tion of bladder neck in X axis and Y axis((Djx,Dzx,Djy,Dzy)during resting period and tension period,the vesicourethral angle(αj,αz),the Bladder angle(βj,βz). The moving of the bladder neck in X axis(ΔDx=Dzx-Djx)and Y axis(ΔDy=Dzy-Djy),as well as the bladder rotation an?gle(Δβ=βz-βj)were calculated and the movement of the bladder neck(ΔD)was measured,followed by comparative analysis. The threshold val?ues of all ultrasonic parameters were determined by the ROC curve analysis. Results The bladder neck of all three groups were backward during tension period. Compared with groupⅢ,ΔDy,Djx,Dzx obviously decreased in groupⅠand groupⅡ,whileβj,βz,αj increased significantly.ΔDx of groupⅡwas significantly larger than that of groupⅢ(P<0.05);There was significant difference in Djy,Dzy,ΔD,Δβandαz among the three groups(P<0.05);In ROC curve analysis,when the critical value of Djy,Dzy,ΔDy,ΔD,αz andΔβwas-1.75 cm,-1.71 cm,0.25 cm,0.29 cm,131.5° and 3.5° ,their sensitivity was 88.9%,88.9%,72.2%,83.3%,88.9%and 72.2%,and the specificity was 72.2%,81.8%,72.7%, 95.5%,86.3%and 68.2%,respectively. Conclusions The transperineal ultrasound could clearly show the pelvic floor of the women in late preg?nancy,the bladder urethral support structure damage or defect was more serious in the women in late pregnancy who were suffering from SUI,and the determination of the critical values of all ultrasonic parameters helped the screening of SUI in women in late pregnancy.

Effects of dynamic transperineal ultrasound and dynamic magnetic resonance imaging defecography in the diagnosis of rectocele / 中华消化外科杂志

Objective To evaluate the agreement between dynamic transperineal ultrasound (DTP-US)and dynamic magnetic resonance imaging defecography (DMRD) in the diagnosis of rectocele,and to compare the correlation and difference between the depth of rectocele measured by DTP-US and DMRD.Methods The clinical data of 18 female patients with rectocele who were admitted to the Third Affiliated Hospital of Nanjing University of Chinese Medicine from September 2011 to May 2012 were retrospectively analyzed.All patients received examination via DTP-US and DMRD,and the agreement of the 2 diagnosing methods was analysed.The accurate rates of the detection of other pelvic floor abnormalities by the 2 methods were calculated.The agreement of DTP-US and DMRD in diagnosing rectocele was analysed by Cohen's kappa test.The difference of the depth of rectocele measured by DTP-US and DMRD was compared by paired samplet test,and the correlation of the depth of rectocele measured by DTP-US and DMRD was analyzed by using the Pearson correlation coefficient.Results Of the 14 patients diagnosed by DTP-US,there were 7 patients with bladder prolapse,5 with unrelaxed pelvic floor,2 with uterine prolapse,2 with rectal internal mucous intussusception and 1 with enterocele; of the 18 patients diagnosed by DMRD,there were 12 patients with bladder prolapse,8 with unrelaxed pelvic floor,8 with uterine prolapse,6 with rectal internal mucous intussusception and 1 with enterocele.The agreement coefficient between DTP-US and DMRD in diagnosing rectocele was obvious (κ =0.737,P ＜ 0.05).The depth of the rectocele detected by DTP-US and DMRD were (15 ±6)mm (range,7-24 mm) and (27 ±7)mm (range,20-41 mm),with significant difference between the 2 groups (t =-16.124,P ＜0.05).There was a high coefficient between DTP-US and DMRD in detecting the depth of rectocele (| r | =0.874,P ＜ 0.05).The depth of rectocele detected by DMRD increased as the increase of depth of rectocele detected by DTP-US (| r | =1.000,P ＜ 0.05).Conclusions The agreement between DTP-US and DMRD in diagnosing rectocele is high.The depth of rectocele measured by the 2 methods not only has statistically significance,but also exists a high degree of correlation.While DTP-US is superior to DMRD in terms of quick diagnosis and better telerance of patients.