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125 - RELATIONSHIP BETWEEN 3D TRANSPERINEAL ULTRASOUND IMAGING AND DIGITAL INTRA-VAGINAL PALPATION ASSESSMENTS OF THE PELVIC FLOOR MUSCLES

125

RELATIONSHIP BETWEEN 3DTRANSPERINEAL ULTRASOUND IMAGING AND DIGITAL INTRA-VAGINAL PALPATIONASSESSMENTS OF THE PELVIC FLOOR MUSCLES

S. THIBAULT-GAGNON 1, L.B. MCLEAN2, C. GOLDFINGER 1, C. PUKALL 1,S. CHAMBERLAIN 1;
1Queen's Univ., Kingston,Canada, 2Univ. of Ottawa, Ottawa, Canada.

Introduction: There is no “goldstandard” in the assessment of pelvic floor muscle (PFM) function,yet digital intra-vaginal palpation remains the favored clinicalassessment approach because it is quick, easy, and no equipment isrequired [1]. However, palpation is subjective; it also lacksprecision, has questionable reliability [2], and may not be suitablefor all women. In particular, PFM palpation outcomes in women whoexperience pain with vaginal penetration, such as those with provokedvestibulodynia (PVD), may be confounded by reactions to pain.Transperineal ultrasound imaging is a non-invasive, objective andreliable means of assessing PFM morphology and function, and has beenproposed as an alternative to digital palpation for PFM assessment[3]. It is essential that we understand the association betweenmorphological measures made based on transperineal ultrasound imagingand PFM outcomes generated through digital intra-vaginalpalpation.
Objective: The aim of this study was todetermine the relationships among measures of levator hiatalmorphology and morphologic changes during maximum effort voluntarycontraction (MVC) and Valsalva tasks assessed using 3D transperinealultrasound and measures of PFM strength, flexibility and toneassessed using intra-vaginal palpation.
Methods: Inseventy-seven nulliparous, premenopausal women, n=38 with PVD andn=39 without a history of genital pain, digital palpation was used toassess PFM strength, tone, relaxation after PFM MVC, and flexibilityof the distal vagina; each scored using an ordinal grading scale. 3Dtransperineal ultrasound imaging was used to measure levator hiataldimensions (area, antero-posterior and transverse diameters; seeFigure 1) at rest, on PFM MVC, and on maximal Valsalva maneuver.Ultrasound data were analyzed offline by an investigator blinded toall clinical data. Spearman’s correlation coefficients were used toassess the relationships between ultrasound andpalpation measures. Ultrasound measures included levator hiataldimensions at rest, on MVC and on maximal Valsalva, as well aschanges in hiatal dimensions between rest and MVC and between restand maximal Valsalva.


Figure 1. The levator hiatus areais bordered by the solid tracing, the antero-posterior diameter isdenoted by the dotted line, and the transverse diameter by the dashedline. The symphysis pubis (SP) is marked by the star, LA denoteslevator ani.
Results: Weak to fair correlations were foundbetween ultrasound and palpation outcomes (See Table 1). A smallerlevator hiatus at rest was associated with greater PFM tone, less PFMrelaxation after MVC and less vaginal flexibility assessed bypalpation. Greater constriction of the levator hiatus and shorteningof the hiatal antero-posterior diameter on PFM MVC was associatedwith greater palpated PFM strength. Greater distension of the levatorhiatus on maximal Valsalva was associated with lower PFM tone andgreater PFM relaxation.

Table1. Correlations between ultrasound and palpation outcomes.


PFMTone

Vaginalflexibility

PFMstrength

PFMrelaxation post-contraction


Correlationwith LH measures at rest





Area(cm2)

-0.298*

0.358**

0.219†

-0.324*


APdiameter (cm)

-0.260*

0.244*

ns

ns


TRdiameter (cm)

-0.239*

0.286*

0.209†

-0.268*


Correlationwith change in LH measures on maximal contraction





Area(cm2)

0.283*

-0.339*

-0.247*

0.290*


APdiameter (cm)

0.271*

-0.288*

-0.231*

0.217†


TRdiameter (cm)

ns

-0.213

ns

0.229


Correlationwith change in LH measures on maximal Valsalva





Area(cm2)

-0.283*

0.231†

ns

-0.397**


APdiameter (cm)

ns

ns

ns

ns


TRdiameter (cm)

ns

-0.241†

0.206†

ns


PFM=pelvicfloor muscle; LH=levator hiatal; AP=antero-posterior;TR=transverse; ns=non-significant; *denotes p≤0.05; **denotesp≤0.001; † denotes 0.05<p≤ 0.1.







Conclusions: Althoughcorrelated, transperineal ultrasound imaging and digitalintra-vaginal palpation contribute different information about PFMfunction. The results of this study are helpful in the interpretationof reports on differences in morphological features of the levatorhiatus seen among different cohorts of women. Although ultrasoundimaging can provide valuable information about PFM morphology andfunction, fair/weak correlations with palpation outcomes suggest thatit should not be used in lieu of digital palpation for the clinicalassessment of PFM strength, flexibility or tone.
References:1. Phys Ther. 2005;85(3):269-282. 2. Acta Obstet Gynecol Scand.2001;80(10):883-887. 3. Ultrasound Obstet Gynecol.2015;45(2):217-222.