The Experts below are selected from a list of 306 Experts worldwide ranked by ideXlab platform
C H Van Der Vaart - One of the best experts on this subject based on the ideXlab platform.
-
structural changes in Puborectalis Muscle after vaginal delivery
Ultrasound in Obstetrics & Gynecology, 2019Co-Authors: M K Van De Waarsenburg, C H Van Der Vaart, Mariella I J WithagenAbstract:OBJECTIVE: To evaluate the structural composition of the Puborectalis Muscle before and at several timepoints after first vaginal delivery, by the use of echogenicity and area measurements, in order to explore its recovery. METHODS: Twenty nulliparous women with a singleton pregnancy underwent 3D/4D transperineal ultrasound assessments at rest, on pelvic floor Muscle contraction and on Valsalva maneuver at 12 weeks' gestation and at 1 day and 1, 2, 3, 4, 6, 12, 18 and 24 weeks after vaginal delivery. The Puborectalis Muscle was delineated for measurements of mean echogenicity (MEP) and area (PMA). To assess changes in MEP and PMA over time, linear mixed model analysis was used. The exact number of days after delivery at each ultrasound examination was used as a covariate. RESULTS: For all timepoints after delivery, MEP was significantly decreased compared with that at 12 weeks' gestation. MEP values increased significantly over time from 1 day to 24 weeks after delivery. Although not statistically significant, a decrease in MEP was observed between 3 and 4 weeks after delivery for all maneuvers. PMA at rest and on Valsalva maneuver remained constant after delivery. CONCLUSION: When compared with measurements taken during pregnancy, a sharp decrease in MEP was observed soon after vaginal delivery, which was most likely caused by stretch trauma to the Puborectalis Muscle and subsequent formation of (micro) hematoma and edema. Subsequent increases in MEP may reflect the disappearance of hematoma and edema, and also the formation of connective and scar tissue. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
-
recovery of Puborectalis Muscle after vaginal delivery an ultrasound study
Ultrasound in Obstetrics & Gynecology, 2018Co-Authors: M K Van De Waarsenburg, C H Van Der Vaart, E A Verberne, Mariella I J WithagenAbstract:OBJECTIVES: To assess change in levator hiatal dimensions between pregnancy and different timepoints after vaginal delivery, and map recovery of the hiatus in order to contribute to secondary prevention of symptoms of pelvic floor disorders. METHODS: Twenty nulliparous women with a singleton pregnancy underwent ultrasound assessment of the pelvic floor at rest, on maximum pelvic floor Muscle contraction (PFMC) and on Valsalva maneuver at 12 weeks' gestation and at 1 day and 1, 2, 3, 4, 6, 12, 18 and 24 weeks after vaginal delivery. Dimensions of the levator hiatus were measured and contractility and distensibility were calculated. The Wilcoxon signed rank test was used to compare each postpartum value with that at 12 weeks' gestation. RESULTS: Levator hiatal area at rest, on PFMC and on Valsalva maneuver was significantly increased at 1 day and at 1 and 2 weeks after vaginal delivery compared with measurements at 12 weeks' gestation. Hiatal area at rest and on PFMC from 3 weeks postpartum onward, as well as contractility from 6 weeks onward, were comparable to values at 12 weeks' gestation, whereas, a significant difference remained on Valsalva maneuver until 24 weeks after delivery. Moreover, distensibility was still increased at 24 weeks postpartum compared with measurements at 12 weeks' gestation. CONCLUSION: The Puborectalis Muscle has the ability to recover anatomically from a first vaginal delivery, and recovery occurs mainly during the first 3 weeks after delivery. Stretching of the Puborectalis Muscle, as reflected by distensibility, persisted 24 weeks after the first vaginal delivery. The data provide a better understanding of the early 'normal' regeneration process and we hypothesize that the first 3 weeks postpartum is the best window in which to start secondary prevention. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
-
changes in global strain of Puborectalis Muscle during pregnancy and postpartum
Ultrasound in Obstetrics & Gynecology, 2018Co-Authors: Anique T M Grob, N Hitschrich, M K Van De Waarsenburg, Mariella I J Withagen, Karlijn J Schweitzer, C H Van Der VaartAbstract:OBJECTIVE: One of the functional parameters that can be assessed by ultrasound is Muscle strain, which represents the extent of deformation of the Muscle from its original shape when forces are applied to the tissue under study. The aim of this study was to evaluate the effect of pregnancy and delivery on the Puborectalis Muscle, by assessing changes in global strain of the Muscle during and after pregnancy. METHODS: This was a secondary analysis of a prospective observational study on the association between stress urinary incontinence and levator ani Muscle avulsion after delivery. Two-hundred and eighty nulliparous pregnant women underwent four-dimensional transperineal ultrasound assessments at 12 and 36 weeks of gestation, and 6 months postpartum. Tomographic ultrasound images were constructed and the Puborectalis Muscle was delineated by hand using programming software. After delineation, the length of the midline of the Puborectalis Muscle was measured at rest and during maximum pelvic floor Muscle contraction, and global strain was expressed as percentile difference. Postpartum results were analyzed separately for vaginal, operative (vacuum) vaginal and Cesarean delivery. Differences in global strain of the Puborectalis Muscle according to mode of delivery were compared using a paired-sample t-test. The effect of partial or complete avulsion of the Puborectalis Muscle on postpartum strain was evaluated by ANOVA. RESULTS: In total, 254 datasets were analyzed. Global strain of the Puborectalis Muscle did not change during pregnancy, but after spontaneous or operative vaginal delivery the global strain diminished significantly. No significant change was observed in strain of the Puborectalis Muscle after Cesarean delivery. Women who suffered complete bilateral avulsion had significantly lower strain compared with women with an intact Puborectalis Muscle. CONCLUSION: Spontaneous or operative vacuum vaginal birth and complete bilateral avulsion of the Puborectalis Muscle influence negatively the strain of the Puborectalis Muscle. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
-
changes in the mean echogenicity and area of the Puborectalis Muscle during pregnancy and postpartum
International Urogynecology Journal, 2016Co-Authors: Anique T M Grob, M K Van De Waarsenburg, Mariella I J Withagen, Karlijn J Schweitzer, C H Van Der VaartAbstract:Introduction and hypothesis Three-dimensional (3D) and four-dimensional (4D) volume transperineal ultrasound imaging is increasingly used to assess changes in the dimensions of the pelvic floor during pregnancy and after delivery. Little is known with regard to the area of the Puborectalis Muscle and its structural changes. Echogenicity measurement, a parameter that provides information on the structure of Muscles, is increasingly used in orthopaedics and neuromuscular disease evaluation. This study is aimed at assessing the changes in the mean echogenicity of the Puborectalis Muscle (MEP) and the Puborectalis Muscle area (PMA) during first pregnancy and after childbirth.
-
association of first trimester echogenicity of the Puborectalis Muscle with mode of delivery
Obstetrics & Gynecology, 2016Co-Authors: Anique T M Grob, M K Van De Waarsenburg, Mariella I J Withagen, Karlijn J Schweitzer, C H Van Der VaartAbstract:OBJECTIVE: To evaluate the association between mean echogenicity of the Puborectalis Muscle, measured using transperineal ultrasonography, in women during their first pregnancy and the subsequent mode of delivery. METHODS: This is a secondary analysis of a prospective observational study on the association between stress urinary incontinence and levator Muscle avulsion after delivery of a first pregnancy. In this study, 280 nulliparous women with singleton pregnancies were examined with transperineal ultrasound examination at 12 and 36 weeks of gestation. Patients were recruited from an obstetrics practice associated with the university medical center in Utrecht, the Netherlands. Mean echogenicity of the Puborectalis Muscle values were measured at rest, in pelvic floor Muscle contraction, and during the Valsalva maneuver. The subsequent mode of delivery was classified into five categories: spontaneous vaginal delivery, instrumental vaginal delivery, elective cesarean delivery, cesarean delivery resulting from nonreassuring fetal status, and cesarean delivery resulting from failure to progress. Mean echogenicity of the Puborectalis Muscle values according to mode of delivery were compared by analysis of variance and Tukey's post hoc test. RESULTS: Of the 254 women included, 157 had spontaneous vaginal delivery, 47 underwent cesarean delivery (11 elective, 36 emergency), and 45 had vacuum operative vaginal delivery; in five patient files, the mode of delivery was not recorded. Of the analyzed women, those who delivered by cesarean because of failure to progress had a significantly lower mean echogenicity of the Puborectalis Muscle in pelvic floor contraction at 12 weeks of gestation (mean echogenicity of 116±14) than women who had spontaneous vaginal delivery (132±21; Tukey's post hoc test, P=.03), instrumental vaginal delivery (138±21; P=.004), and cesarean delivery resulting from nonreassuring fetal status (139±20; P=.02). CONCLUSION: Lower mean echogenicity of the Puborectalis Muscle values in pelvic floor contraction during the first pregnancy at 12 weeks of gestation is associated with subsequent cesarean delivery as a result of failure to progress.
Anique T M Grob - One of the best experts on this subject based on the ideXlab platform.
-
deep learning enables automatic quantitative assessment of Puborectalis Muscle and urogenital hiatus in plane of minimal hiatal dimensions
Ultrasound in Obstetrics & Gynecology, 2019Co-Authors: Anique T M Grob, F Van Den Noort, Cornelis H Slump, C H Van Der Vaart, M K Van De Waarsenburg, M Van StralenAbstract:Objectives To measure the length, width and area of the urogenital hiatus (UH), and the length and mean echogenicity (MEP) of the Puborectalis Muscle (PRM), automatically and observer-independently, in the plane of minimal hiatal dimensions on transperineal ultrasound (TPUS) images, by automatic segmentation of the UH and the PRM using deep learning. Methods In 1318 three- and four-dimensional (3D/4D) TPUS volume datasets from 253 nulliparae at 12 and 36 weeks' gestation, two-dimensional (2D) images in the plane of minimal hiatal dimensions with the PRM at rest, on maximum contraction and on maximum Valsalva maneuver, were obtained manually and the UH and PRM were segmented manually. In total, 713 of the images were used to train a convolutional neural network (CNN) to segment automatically the UH and PRM in the plane of minimal hiatal dimensions. In the remainder of the dataset (test set 1 (TS1); 601 images, four having been excluded), the performance of the CNN was evaluated by comparing automatic and manual segmentations. The performance of the CNN was also tested on 117 images from an independent dataset (test set 2 (TS2); two images having been excluded) from 40 nulliparae at 12 weeks' gestation, which were acquired and segmented manually by a different observer. The success of automatic segmentation was assessed visually. Based on the CNN segmentations, the following clinically relevant parameters were measured: the length, width and area of the UH, the length of the PRM and MEP. The overlap (Dice similarity index (DSI)) and surface distance (mean absolute distance (MAD) and Hausdorff distance (HDD)) between manual and CNN segmentations were measured to investigate their similarity. For the measured clinically relevant parameters, the intraclass correlation coefficients (ICCs) between manual and CNN results were determined. Results Fully automatic CNN segmentation was successful in 99.0% and 93.2% of images in TS1 and TS2, respectively. DSI, MAD and HDD showed good overlap and distance between manual and CNN segmentations in both test sets. This was reflected in the respective ICC values in TS1 and TS2 for the length (0.96 and 0.95), width (0.77 and 0.87) and area (0.96 and 0.91) of the UH, the length of the PRM (0.87 and 0.73) and MEP (0.95 and 0.97), which showed good to very good agreement. Conclusion Deep learning can be used to segment automatically and reliably the PRM and UH on 2D ultrasound images of the nulliparous pelvic floor in the plane of minimal hiatal dimensions. These segmentations can be used to measure reliably UH dimensions as well as PRM length and MEP. © 2018 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
-
Deep learning enables automatic quantitative assessment of Puborectalis Muscle and urogenital hiatus in plane of minimal hiatal dimensions.
Ultrasound in Obstetrics & Gynecology, 2019Co-Authors: F Van Den Noort, Anique T M Grob, Cornelis H Slump, C H Van Der Vaart, M K Van De Waarsenburg, M Van StralenAbstract:OBJECTIVES: To measure the length, width and area of the urogenital hiatus (UH), and the length and mean echogenicity (MEP) of the Puborectalis Muscle (PRM), automatically and observer-independently, in the plane of minimal hiatal dimensions on transperineal ultrasound (TPUS) images, by automatic segmentation of the UH and the PRM using deep learning. METHODS: In 1318 three- and four-dimensional (3D/4D) TPUS volume datasets from 253 nulliparae at 12 and 36 weeks' gestation, two-dimensional (2D) images in the plane of minimal hiatal dimensions with the PRM at rest, on maximum contraction and on maximum Valsalva maneuver, were obtained manually and the UH and PRM were segmented manually. In total, 713 of the images were used to train a convolutional neural network (CNN) to segment automatically the UH and PRM in the plane of minimal hiatal dimensions. In the remainder of the dataset (test set 1 (TS1); 601 images, four having been excluded), the performance of the CNN was evaluated by comparing automatic and manual segmentations. The performance of the CNN was also tested on 117 images from an independent dataset (test set 2 (TS2); two images having been excluded) from 40 nulliparae at 12 weeks' gestation, which were acquired and segmented manually by a different observer. The success of automatic segmentation was assessed visually. Based on the CNN segmentations, the following clinically relevant parameters were measured: the length, width and area of the UH, the length of the PRM and MEP. The overlap (Dice similarity index (DSI)) and surface distance (mean absolute distance (MAD) and Hausdorff distance (HDD)) between manual and CNN segmentations were measured to investigate their similarity. For the measured clinically relevant parameters, the intraclass correlation coefficients (ICCs) between manual and CNN results were determined. RESULTS: Fully automatic CNN segmentation was successful in 99.0% and 93.2% of images in TS1 and TS2, respectively. DSI, MAD and HDD showed good overlap and distance between manual and CNN segmentations in both test sets. This was reflected in the respective ICC values in TS1 and TS2 for the length (0.96 and 0.95), width (0.77 and 0.87) and area (0.96 and 0.91) of the UH, the length of the PRM (0.87 and 0.73) and MEP (0.95 and 0.97), which showed good to very good agreement. CONCLUSION: Deep learning can be used to segment automatically and reliably the PRM and UH on 2D ultrasound images of the nulliparous pelvic floor in the plane of minimal hiatal dimensions. These segmentations can be used to measure reliably UH dimensions as well as PRM length and MEP. © 2018 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
-
automatic segmentation of Puborectalis Muscle on three dimensional transperineal ultrasound
Ultrasound in Obstetrics & Gynecology, 2018Co-Authors: Anique T M Grob, F Van Den Noort, Cornelis H Slump, C H Van Der Vaart, M Van StralenAbstract:OBJECTIVES: The introduction of three-dimensional (3D) analysis of the Puborectalis Muscle (PRM) for diagnostic purposes into daily practice is hindered by the need for appropriate training of observers. Automatic segmentation of the PRM on 3D transperineal ultrasound may aid its integration into clinical practice. The aims of this study were to present and assess a protocol for manual 3D segmentation of the PRM on 3D transperineal ultrasound, and to use this for training of automatic 3D segmentation method of the PRM. METHODS: The data used in this study were derived from 3D transperineal ultrasound sequences of the pelvic floor acquired at 12 weeks' gestation from nulliparous women with a singleton pregnancy. A manual 3D segmentation protocol was developed for the PRM based on a validated two-dimensional segmentation protocol. For automatic segmentation, active appearance models of the PRM were developed, trained using manual segmentation data from 50 women. The performances of both manual and automatic segmentation were analyzed by measuring the overlap and distance between the segmentations. Intraclass correlation coefficients (ICCs) and their 95% CIs were determined for mean echogenicity and volume of the Puborectalis Muscle, in order to assess inter- and intraobserver reliabilities of the manual method using data from 20 women, as well as to compare the manual and automatic methods. RESULTS: Interobserver reliabilities for mean echogenicity and volume were very good for manual segmentation (ICCs 0.987 and 0.910, respectively), as were intraobserver reliabilities (ICCs 0.991 and 0.877, respectively). ICCs for mean echogenicity and volume were very good and good, respectively, for the comparison of manual vs automatic segmentation (0.968 and 0.626, respectively). The overlap and distance results for manual segmentation were as expected, showing an average mismatch of only 2-3 pixels and reasonable overlap. Based on overlap and distance, five mismatches were detected for automatic segmentation, resulting in an automatic segmentation success rate of 90%. CONCLUSIONS: This study presents a reliable manual segmentation protocol and automatic 3D segmentation method for the PRM, which will facilitate future investigation of the PRM, allowing for the reliable measurement of potentially clinically valuable parameters such as mean echogenicity. © 2017 The Authors. Ultrasound in Obstetrics & Gynecology Published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
-
changes in global strain of Puborectalis Muscle during pregnancy and postpartum
Ultrasound in Obstetrics & Gynecology, 2018Co-Authors: Anique T M Grob, N Hitschrich, M K Van De Waarsenburg, Mariella I J Withagen, Karlijn J Schweitzer, C H Van Der VaartAbstract:OBJECTIVE: One of the functional parameters that can be assessed by ultrasound is Muscle strain, which represents the extent of deformation of the Muscle from its original shape when forces are applied to the tissue under study. The aim of this study was to evaluate the effect of pregnancy and delivery on the Puborectalis Muscle, by assessing changes in global strain of the Muscle during and after pregnancy. METHODS: This was a secondary analysis of a prospective observational study on the association between stress urinary incontinence and levator ani Muscle avulsion after delivery. Two-hundred and eighty nulliparous pregnant women underwent four-dimensional transperineal ultrasound assessments at 12 and 36 weeks of gestation, and 6 months postpartum. Tomographic ultrasound images were constructed and the Puborectalis Muscle was delineated by hand using programming software. After delineation, the length of the midline of the Puborectalis Muscle was measured at rest and during maximum pelvic floor Muscle contraction, and global strain was expressed as percentile difference. Postpartum results were analyzed separately for vaginal, operative (vacuum) vaginal and Cesarean delivery. Differences in global strain of the Puborectalis Muscle according to mode of delivery were compared using a paired-sample t-test. The effect of partial or complete avulsion of the Puborectalis Muscle on postpartum strain was evaluated by ANOVA. RESULTS: In total, 254 datasets were analyzed. Global strain of the Puborectalis Muscle did not change during pregnancy, but after spontaneous or operative vaginal delivery the global strain diminished significantly. No significant change was observed in strain of the Puborectalis Muscle after Cesarean delivery. Women who suffered complete bilateral avulsion had significantly lower strain compared with women with an intact Puborectalis Muscle. CONCLUSION: Spontaneous or operative vacuum vaginal birth and complete bilateral avulsion of the Puborectalis Muscle influence negatively the strain of the Puborectalis Muscle. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
-
changes in the mean echogenicity and area of the Puborectalis Muscle during pregnancy and postpartum
International Urogynecology Journal, 2016Co-Authors: Anique T M Grob, M K Van De Waarsenburg, Mariella I J Withagen, Karlijn J Schweitzer, C H Van Der VaartAbstract:Introduction and hypothesis Three-dimensional (3D) and four-dimensional (4D) volume transperineal ultrasound imaging is increasingly used to assess changes in the dimensions of the pelvic floor during pregnancy and after delivery. Little is known with regard to the area of the Puborectalis Muscle and its structural changes. Echogenicity measurement, a parameter that provides information on the structure of Muscles, is increasingly used in orthopaedics and neuromuscular disease evaluation. This study is aimed at assessing the changes in the mean echogenicity of the Puborectalis Muscle (MEP) and the Puborectalis Muscle area (PMA) during first pregnancy and after childbirth.
Mariella I J Withagen - One of the best experts on this subject based on the ideXlab platform.
-
echogenicity of Puborectalis Muscle cervix and vastus lateralis Muscle in pregnancy in relation to mode of delivery
Ultrasound in Obstetrics & Gynecology, 2019Co-Authors: M K Van De Waarsenburg, Mariella I J Withagen, F Van Den Noort, J Schagen H Van Leeuwen, C H Van Der VaartAbstract:Objectives: To confirm our previous observation that levator hiatal dimensions and mean echogenicity of the Puborectalis Muscle (MEP) are significantly different at 12 weeks' gestation in women who delivered by Cesarean section due to failure to progress compared with those who delivered vaginally. The secondary objective was to assess the association between the echogenicity of the cervix and vastus lateralis Muscle and mode of delivery. Methods: In this prospective multicenter study, 306 nulliparous women with a singleton pregnancy underwent ultrasound assessments of the pelvic floor at rest, on maximum pelvic floor Muscle contraction and on maximum Valsalva maneuver, of the cervix and of the vastus lateralis Muscle at 12 weeks' gestation. Dimensions of the levator hiatus, MEP and mean echogenicity of the cervix and vastus lateralis Muscle were measured and compared according to mode of delivery. Results: Two hundred and forty-nine women were included in the analyses. We were unable to confirm our previous finding that MEP and levator hiatal transverse diameter and area at 12 weeks' gestation are associated significantly with mode of delivery. In addition, we could not demonstrate a significant association between echogenicity of the cervix or vastus lateralis Muscle and mode of delivery. Overall, MEP was a mean of 20 points lower in women in the new database as compared with the previous study, despite the use of the same ultrasound equipment. Conclusion: In a second, independent multicenter dataset, we were unable to confirm our previous finding that levator hiatal dimensions and MEP on pelvic floor Muscle contraction are associated significantly with mode of delivery. We also found no association between echogenicity of the cervix or vastus lateralis and mode of delivery.
-
structural changes in Puborectalis Muscle after vaginal delivery
Ultrasound in Obstetrics & Gynecology, 2019Co-Authors: M K Van De Waarsenburg, C H Van Der Vaart, Mariella I J WithagenAbstract:OBJECTIVE: To evaluate the structural composition of the Puborectalis Muscle before and at several timepoints after first vaginal delivery, by the use of echogenicity and area measurements, in order to explore its recovery. METHODS: Twenty nulliparous women with a singleton pregnancy underwent 3D/4D transperineal ultrasound assessments at rest, on pelvic floor Muscle contraction and on Valsalva maneuver at 12 weeks' gestation and at 1 day and 1, 2, 3, 4, 6, 12, 18 and 24 weeks after vaginal delivery. The Puborectalis Muscle was delineated for measurements of mean echogenicity (MEP) and area (PMA). To assess changes in MEP and PMA over time, linear mixed model analysis was used. The exact number of days after delivery at each ultrasound examination was used as a covariate. RESULTS: For all timepoints after delivery, MEP was significantly decreased compared with that at 12 weeks' gestation. MEP values increased significantly over time from 1 day to 24 weeks after delivery. Although not statistically significant, a decrease in MEP was observed between 3 and 4 weeks after delivery for all maneuvers. PMA at rest and on Valsalva maneuver remained constant after delivery. CONCLUSION: When compared with measurements taken during pregnancy, a sharp decrease in MEP was observed soon after vaginal delivery, which was most likely caused by stretch trauma to the Puborectalis Muscle and subsequent formation of (micro) hematoma and edema. Subsequent increases in MEP may reflect the disappearance of hematoma and edema, and also the formation of connective and scar tissue. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
-
recovery of Puborectalis Muscle after vaginal delivery an ultrasound study
Ultrasound in Obstetrics & Gynecology, 2018Co-Authors: M K Van De Waarsenburg, C H Van Der Vaart, E A Verberne, Mariella I J WithagenAbstract:OBJECTIVES: To assess change in levator hiatal dimensions between pregnancy and different timepoints after vaginal delivery, and map recovery of the hiatus in order to contribute to secondary prevention of symptoms of pelvic floor disorders. METHODS: Twenty nulliparous women with a singleton pregnancy underwent ultrasound assessment of the pelvic floor at rest, on maximum pelvic floor Muscle contraction (PFMC) and on Valsalva maneuver at 12 weeks' gestation and at 1 day and 1, 2, 3, 4, 6, 12, 18 and 24 weeks after vaginal delivery. Dimensions of the levator hiatus were measured and contractility and distensibility were calculated. The Wilcoxon signed rank test was used to compare each postpartum value with that at 12 weeks' gestation. RESULTS: Levator hiatal area at rest, on PFMC and on Valsalva maneuver was significantly increased at 1 day and at 1 and 2 weeks after vaginal delivery compared with measurements at 12 weeks' gestation. Hiatal area at rest and on PFMC from 3 weeks postpartum onward, as well as contractility from 6 weeks onward, were comparable to values at 12 weeks' gestation, whereas, a significant difference remained on Valsalva maneuver until 24 weeks after delivery. Moreover, distensibility was still increased at 24 weeks postpartum compared with measurements at 12 weeks' gestation. CONCLUSION: The Puborectalis Muscle has the ability to recover anatomically from a first vaginal delivery, and recovery occurs mainly during the first 3 weeks after delivery. Stretching of the Puborectalis Muscle, as reflected by distensibility, persisted 24 weeks after the first vaginal delivery. The data provide a better understanding of the early 'normal' regeneration process and we hypothesize that the first 3 weeks postpartum is the best window in which to start secondary prevention. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
-
changes in global strain of Puborectalis Muscle during pregnancy and postpartum
Ultrasound in Obstetrics & Gynecology, 2018Co-Authors: Anique T M Grob, N Hitschrich, M K Van De Waarsenburg, Mariella I J Withagen, Karlijn J Schweitzer, C H Van Der VaartAbstract:OBJECTIVE: One of the functional parameters that can be assessed by ultrasound is Muscle strain, which represents the extent of deformation of the Muscle from its original shape when forces are applied to the tissue under study. The aim of this study was to evaluate the effect of pregnancy and delivery on the Puborectalis Muscle, by assessing changes in global strain of the Muscle during and after pregnancy. METHODS: This was a secondary analysis of a prospective observational study on the association between stress urinary incontinence and levator ani Muscle avulsion after delivery. Two-hundred and eighty nulliparous pregnant women underwent four-dimensional transperineal ultrasound assessments at 12 and 36 weeks of gestation, and 6 months postpartum. Tomographic ultrasound images were constructed and the Puborectalis Muscle was delineated by hand using programming software. After delineation, the length of the midline of the Puborectalis Muscle was measured at rest and during maximum pelvic floor Muscle contraction, and global strain was expressed as percentile difference. Postpartum results were analyzed separately for vaginal, operative (vacuum) vaginal and Cesarean delivery. Differences in global strain of the Puborectalis Muscle according to mode of delivery were compared using a paired-sample t-test. The effect of partial or complete avulsion of the Puborectalis Muscle on postpartum strain was evaluated by ANOVA. RESULTS: In total, 254 datasets were analyzed. Global strain of the Puborectalis Muscle did not change during pregnancy, but after spontaneous or operative vaginal delivery the global strain diminished significantly. No significant change was observed in strain of the Puborectalis Muscle after Cesarean delivery. Women who suffered complete bilateral avulsion had significantly lower strain compared with women with an intact Puborectalis Muscle. CONCLUSION: Spontaneous or operative vacuum vaginal birth and complete bilateral avulsion of the Puborectalis Muscle influence negatively the strain of the Puborectalis Muscle. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
-
changes in the mean echogenicity and area of the Puborectalis Muscle during pregnancy and postpartum
International Urogynecology Journal, 2016Co-Authors: Anique T M Grob, M K Van De Waarsenburg, Mariella I J Withagen, Karlijn J Schweitzer, C H Van Der VaartAbstract:Introduction and hypothesis Three-dimensional (3D) and four-dimensional (4D) volume transperineal ultrasound imaging is increasingly used to assess changes in the dimensions of the pelvic floor during pregnancy and after delivery. Little is known with regard to the area of the Puborectalis Muscle and its structural changes. Echogenicity measurement, a parameter that provides information on the structure of Muscles, is increasingly used in orthopaedics and neuromuscular disease evaluation. This study is aimed at assessing the changes in the mean echogenicity of the Puborectalis Muscle (MEP) and the Puborectalis Muscle area (PMA) during first pregnancy and after childbirth.
M K Van De Waarsenburg - One of the best experts on this subject based on the ideXlab platform.
-
structural changes in Puborectalis Muscle after vaginal delivery
Ultrasound in Obstetrics & Gynecology, 2019Co-Authors: M K Van De Waarsenburg, C H Van Der Vaart, Mariella I J WithagenAbstract:OBJECTIVE: To evaluate the structural composition of the Puborectalis Muscle before and at several timepoints after first vaginal delivery, by the use of echogenicity and area measurements, in order to explore its recovery. METHODS: Twenty nulliparous women with a singleton pregnancy underwent 3D/4D transperineal ultrasound assessments at rest, on pelvic floor Muscle contraction and on Valsalva maneuver at 12 weeks' gestation and at 1 day and 1, 2, 3, 4, 6, 12, 18 and 24 weeks after vaginal delivery. The Puborectalis Muscle was delineated for measurements of mean echogenicity (MEP) and area (PMA). To assess changes in MEP and PMA over time, linear mixed model analysis was used. The exact number of days after delivery at each ultrasound examination was used as a covariate. RESULTS: For all timepoints after delivery, MEP was significantly decreased compared with that at 12 weeks' gestation. MEP values increased significantly over time from 1 day to 24 weeks after delivery. Although not statistically significant, a decrease in MEP was observed between 3 and 4 weeks after delivery for all maneuvers. PMA at rest and on Valsalva maneuver remained constant after delivery. CONCLUSION: When compared with measurements taken during pregnancy, a sharp decrease in MEP was observed soon after vaginal delivery, which was most likely caused by stretch trauma to the Puborectalis Muscle and subsequent formation of (micro) hematoma and edema. Subsequent increases in MEP may reflect the disappearance of hematoma and edema, and also the formation of connective and scar tissue. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
-
recovery of Puborectalis Muscle after vaginal delivery an ultrasound study
Ultrasound in Obstetrics & Gynecology, 2018Co-Authors: M K Van De Waarsenburg, C H Van Der Vaart, E A Verberne, Mariella I J WithagenAbstract:OBJECTIVES: To assess change in levator hiatal dimensions between pregnancy and different timepoints after vaginal delivery, and map recovery of the hiatus in order to contribute to secondary prevention of symptoms of pelvic floor disorders. METHODS: Twenty nulliparous women with a singleton pregnancy underwent ultrasound assessment of the pelvic floor at rest, on maximum pelvic floor Muscle contraction (PFMC) and on Valsalva maneuver at 12 weeks' gestation and at 1 day and 1, 2, 3, 4, 6, 12, 18 and 24 weeks after vaginal delivery. Dimensions of the levator hiatus were measured and contractility and distensibility were calculated. The Wilcoxon signed rank test was used to compare each postpartum value with that at 12 weeks' gestation. RESULTS: Levator hiatal area at rest, on PFMC and on Valsalva maneuver was significantly increased at 1 day and at 1 and 2 weeks after vaginal delivery compared with measurements at 12 weeks' gestation. Hiatal area at rest and on PFMC from 3 weeks postpartum onward, as well as contractility from 6 weeks onward, were comparable to values at 12 weeks' gestation, whereas, a significant difference remained on Valsalva maneuver until 24 weeks after delivery. Moreover, distensibility was still increased at 24 weeks postpartum compared with measurements at 12 weeks' gestation. CONCLUSION: The Puborectalis Muscle has the ability to recover anatomically from a first vaginal delivery, and recovery occurs mainly during the first 3 weeks after delivery. Stretching of the Puborectalis Muscle, as reflected by distensibility, persisted 24 weeks after the first vaginal delivery. The data provide a better understanding of the early 'normal' regeneration process and we hypothesize that the first 3 weeks postpartum is the best window in which to start secondary prevention. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
-
changes in global strain of Puborectalis Muscle during pregnancy and postpartum
Ultrasound in Obstetrics & Gynecology, 2018Co-Authors: Anique T M Grob, N Hitschrich, M K Van De Waarsenburg, Mariella I J Withagen, Karlijn J Schweitzer, C H Van Der VaartAbstract:OBJECTIVE: One of the functional parameters that can be assessed by ultrasound is Muscle strain, which represents the extent of deformation of the Muscle from its original shape when forces are applied to the tissue under study. The aim of this study was to evaluate the effect of pregnancy and delivery on the Puborectalis Muscle, by assessing changes in global strain of the Muscle during and after pregnancy. METHODS: This was a secondary analysis of a prospective observational study on the association between stress urinary incontinence and levator ani Muscle avulsion after delivery. Two-hundred and eighty nulliparous pregnant women underwent four-dimensional transperineal ultrasound assessments at 12 and 36 weeks of gestation, and 6 months postpartum. Tomographic ultrasound images were constructed and the Puborectalis Muscle was delineated by hand using programming software. After delineation, the length of the midline of the Puborectalis Muscle was measured at rest and during maximum pelvic floor Muscle contraction, and global strain was expressed as percentile difference. Postpartum results were analyzed separately for vaginal, operative (vacuum) vaginal and Cesarean delivery. Differences in global strain of the Puborectalis Muscle according to mode of delivery were compared using a paired-sample t-test. The effect of partial or complete avulsion of the Puborectalis Muscle on postpartum strain was evaluated by ANOVA. RESULTS: In total, 254 datasets were analyzed. Global strain of the Puborectalis Muscle did not change during pregnancy, but after spontaneous or operative vaginal delivery the global strain diminished significantly. No significant change was observed in strain of the Puborectalis Muscle after Cesarean delivery. Women who suffered complete bilateral avulsion had significantly lower strain compared with women with an intact Puborectalis Muscle. CONCLUSION: Spontaneous or operative vacuum vaginal birth and complete bilateral avulsion of the Puborectalis Muscle influence negatively the strain of the Puborectalis Muscle. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
-
changes in the mean echogenicity and area of the Puborectalis Muscle during pregnancy and postpartum
International Urogynecology Journal, 2016Co-Authors: Anique T M Grob, M K Van De Waarsenburg, Mariella I J Withagen, Karlijn J Schweitzer, C H Van Der VaartAbstract:Introduction and hypothesis Three-dimensional (3D) and four-dimensional (4D) volume transperineal ultrasound imaging is increasingly used to assess changes in the dimensions of the pelvic floor during pregnancy and after delivery. Little is known with regard to the area of the Puborectalis Muscle and its structural changes. Echogenicity measurement, a parameter that provides information on the structure of Muscles, is increasingly used in orthopaedics and neuromuscular disease evaluation. This study is aimed at assessing the changes in the mean echogenicity of the Puborectalis Muscle (MEP) and the Puborectalis Muscle area (PMA) during first pregnancy and after childbirth.
-
association of first trimester echogenicity of the Puborectalis Muscle with mode of delivery
Obstetrics & Gynecology, 2016Co-Authors: Anique T M Grob, M K Van De Waarsenburg, Mariella I J Withagen, Karlijn J Schweitzer, C H Van Der VaartAbstract:OBJECTIVE: To evaluate the association between mean echogenicity of the Puborectalis Muscle, measured using transperineal ultrasonography, in women during their first pregnancy and the subsequent mode of delivery. METHODS: This is a secondary analysis of a prospective observational study on the association between stress urinary incontinence and levator Muscle avulsion after delivery of a first pregnancy. In this study, 280 nulliparous women with singleton pregnancies were examined with transperineal ultrasound examination at 12 and 36 weeks of gestation. Patients were recruited from an obstetrics practice associated with the university medical center in Utrecht, the Netherlands. Mean echogenicity of the Puborectalis Muscle values were measured at rest, in pelvic floor Muscle contraction, and during the Valsalva maneuver. The subsequent mode of delivery was classified into five categories: spontaneous vaginal delivery, instrumental vaginal delivery, elective cesarean delivery, cesarean delivery resulting from nonreassuring fetal status, and cesarean delivery resulting from failure to progress. Mean echogenicity of the Puborectalis Muscle values according to mode of delivery were compared by analysis of variance and Tukey's post hoc test. RESULTS: Of the 254 women included, 157 had spontaneous vaginal delivery, 47 underwent cesarean delivery (11 elective, 36 emergency), and 45 had vacuum operative vaginal delivery; in five patient files, the mode of delivery was not recorded. Of the analyzed women, those who delivered by cesarean because of failure to progress had a significantly lower mean echogenicity of the Puborectalis Muscle in pelvic floor contraction at 12 weeks of gestation (mean echogenicity of 116±14) than women who had spontaneous vaginal delivery (132±21; Tukey's post hoc test, P=.03), instrumental vaginal delivery (138±21; P=.004), and cesarean delivery resulting from nonreassuring fetal status (139±20; P=.02). CONCLUSION: Lower mean echogenicity of the Puborectalis Muscle values in pelvic floor contraction during the first pregnancy at 12 weeks of gestation is associated with subsequent cesarean delivery as a result of failure to progress.
Ravinder K Mittal - One of the best experts on this subject based on the ideXlab platform.
-
Anorectal Anatomy and Function
Anorectal Disorders, 2019Co-Authors: Ravinder K MittalAbstract:Abstract The aim of this chapter is to provide the reader with information on the recent advances in our understanding of anal sphincter anatomy and of imaging and functional assessment tools. There are three distinct anatomical structures, the internal anal sphincter (IAS), external anal sphincter (EAS), and Puborectalis Muscle (PRM), the last one being a part of the pelvic-floor or levator-ani Muscle that contributes to the anal-closure/sphincter mechanism.
-
length tension function of Puborectalis Muscle implications for the treatment of fecal incontinence and pelvic floor disorders
Journal of Neurogastroenterology and Motility, 2014Co-Authors: Ravinder K Mittal, Geoff Sheean, Bikram S Padda, Mahadevan RajasekaranAbstract:BACKGROUND/AIMS: External anal sphincter (EAS) and Puborectalis Muscle (PRM) play important role in anal continence function. Based on length-tension measurement, we recently reported that the human EAS Muscle operates at short sarcomere length under phys-iological conditions. Goal of our study was to determine if PRM also operates at the short sarcomere length. METHODS: Length-tension relationship of the PRM Muscle was studied in vivo in 10 healthy nullipara women. Length was altered by vagi-nal distension using custom-designed probes of 5, 10, 15, 20, 25 and 30 mm diameters as well as by distending a poly-ethylene bag with different volumes of water. Probes were equipped with a reverse perfuse sleeve sensor to measure vaginal pressure (surrogate of PRM tension). PRM electromyogram (EMG) was recorded using wire electrodes. Three-dimensional ultra-sound images were obtained to determine effect of vaginal distension on PRM length. RESULTS: Ultrasound images demonstrate distension volume dependent increase in PRM length. Rest and squeeze pressures of vaginal bag increased with the increase in bag volume. Similarly, the change in vaginal pressure, which represents the PRM contraction increased with the increase in the probe size. Increase in probe size was not associated with an increase in EMG activity (a marker of neural drive) of the PRM. CONCLUSIONS: Probe size dependent increase in PRM contraction pressure, in the presence of constant EMG (neural input) proves that the hu-man PRM operates at short sarcomere length. Surgically adjusting the PRM length may represent a novel strategy to improve treat anal continence and possibly other pelvic floor disorders.(J Neurogastroenterol Motil 2014;20:539-546).
-
role of Puborectalis Muscle in the genesis of urethral pressure
The Journal of Urology, 2012Co-Authors: Raj M Rajasekaran, Dongwan Sohn, Mitra Salehi, Valmik Bhargava, Helga Fritsch, Ravinder K MittalAbstract:Purpose: The internal (smooth Muscle) and the external (rhabdosphincter striated Muscle) urethral sphincters have important roles in the genesis of urethral closure pressure. The U-shaped pelvic floor Puborectalis Muscle is important in the closure of anal and vaginal orifices in humans. We defined the contribution of the Puborectalis to urethral pressure.Materials and Methods: A total of 11 female rabbits were anesthetized and prepared to measure urethral, vaginal and anal canal pressure using manometric methods. Pressure was recorded at rest, after administration of pharmacological agents and during electrical stimulation of the Puborectalis and rhabdosphincter sphincter Muscles. Phenylephrine, sodium nitroprusside (Sigma-Aldrich®) and rocuronium bromide (PharMEDium, Lake Forest, Illinois) were used to define the relative contribution of smooth and striated Muscles to urethral pressure. Histology of the pelvic floor hiatus was also studied.Results: At rest mean ± SEM maximum urethral pressure was 13 ± 6...
-
Closure mechanism of the anal canal in women: assessed by three-dimensional ultrasound imaging.
Diseases of The Colon & Rectum, 2008Co-Authors: Sungae Jung, Dolores H Pretorius, Charles W Nager, Milena Weinstein, Debbie Den-boer, Ravinder K MittalAbstract:PURPOSE: To describe the functional correlates of anal canal anatomy using 3 dimensional ultrasound imaging. METHODS: Ten nulliparous women were studied by using a 10-cm bag of 20-mm diameter. The bag was placed along the anal canal and inflated with 20 to 45 ml water, in 5-ml increments. At each volume, a three-dimensional ultrasound volume of the anal canal was obtained while the subjects were at rest and squeeze. The ultrasound images were analyzed to determine the relationship between the bag cross-sectional area and bag pressure. RESULTS: At low distension volumes, the bag is shaped like an "hourglass." The flared ends of the funnels correspond with the proximal and distal margins of the Puborectalis Muscle and external anal sphincter respectively. With increasing bag volumes, the length of completely closed segment of anal canal decreased. The last anal segment to open at rest was the one surrounded by all three structures. Anal contraction resulted in reduction of the anal canal cross-sectional area; the least compliant part of the anal canal was the one surrounded by external anal sphincter. CONCLUSION: The internal anal sphincter, external anal sphincter, and Puborectalis Muscle are all involved in the anal canal closure function. During contraction, the external anal sphincter is the strongest component of anal canal closure mechanism.
-
p48 01 anatomic defects in the Puborectalis Muscle in women with fecal incontinence
Ultrasound in Obstetrics & Gynecology, 2007Co-Authors: Milena M Weinstein, Dolores H Pretorius, Charles W Nager, S A Jung, Ravinder K MittalAbstract:the pregnancy after multidisciplinary consultation including genetic counseling. At 38 weeks gestational age, the patient delivered a 2956 g male neonate with Apgar scores of 6–9 at 5 and 10 minutes, respectively. In the neonatal physical examinations found penis length of few mm with left cryptorchidism. Neonatal testosterone concentration was 3 ng/mL. HCG treatment was started and circumcision was delayed. This case is unique in the very early diagnosis of severe micropenis.
