New Method for Assessment of Levator Avulsion Injury: A Comparative Elastography Study

Area of Science:

• Obstetrics and Gynecology
• Medical Imaging
• Pelvic Floor Disorders

Background:

• Postpartum pelvic floor trauma is a significant concern affecting women after childbirth.
• Current sonographic methods may not fully capture the extent of pelvic floor trauma.
• Elastography offers a novel approach to assess tissue elasticity and identify abnormalities.

Purpose of the Study:

• To introduce and evaluate elastography as a new sonographic method for assessing postpartum pelvic floor trauma.
• To compare elastography findings with conventional B-mode ultrasonography.
• To determine the utility of elastography in identifying women at risk for pelvic floor disorders.

Main Methods:

• Eighty-six postpartum primiparous women were studied, divided into caesarean section (CS) and vaginal delivery (VD) groups.
• Pelvic floor trauma was evaluated using B-mode and elastographic ultrasonography in the puborectal-symphysis plane.
• The strain ratio maximum (Trauma_Index) of the puborectal muscle was measured to quantify trauma.

Main Results:

• Elastography detected more trauma-suspicious lesions (60.5%) compared to B-mode (39.5%) (P < .001).
• The median Trauma_Index was significantly higher in the vaginal delivery group (1.63) than in the caesarean section group (1.18) (P < .001).

Conclusions:

• Sonographic elastography in a novel examination plane effectively identifies postpartum pelvic floor trauma, particularly after vaginal delivery.
• This new elastographic assessment method shows promise in identifying women at increased risk for postpartum pelvic floor disorders.
• Elastography represents a valuable advancement in the sonographic evaluation of pelvic floor trauma.