BACKGROUND: Pelvic organ prolapse (POP) is a condition characterized by the failure of various anatomic structures to support the pelvic viscera. There has been a growing interest in the understanding of the underlying structural alterations in the pelvic floor, and the use of 2D and 3D transperineal ultrasound has recently been shown to be able to determine biometric indices of the levator hiatus and pubovisceral muscle.
OBJECTIVE: To compare the morphological features and biometric parameters of the pelvic floor of patients with pelvic organ prolapse with age-matched controls using 2D and 3D transperineal ultrasound.
METHODOLOGY: In a prospective case control study, 35 patients with prolapse and 25 asymptomatic controls were assessed. Bladder symphyseal distance (BSD), bladder neck descent, angle of urethral inclination, retrovesical angle, bladder wall thickness and quantification of prolapse were measured on rest and valsalva maneuver on 2D ultrasound. Anteroposterior and lateral diameters, as well as pubovisceral muscle thickness was measured on rest and valsalva on 3D ultrasound.
RESULTS: BSD was significantly lower in the prolapse group (p=0001), while bladder wall thickness was significantly higher (p=0024). AP and lateral diameters were significantly higher in the prolapse group both at rest and on valsalva, showing that there is significant correlation with increased diameters at rest and pelvic organ descent. Pubovisceral muscle thickness was lower in the prolapse group compared to controls both at rest and on valsalva.
CONCLUSION: Levator hiatal dimensions and biometry indices of the pubovisceral muscle can be determined using 2D and 3D transperineal ultrasound. There is significant correlation between anteroposterior and lateral diameters, as well as pubovisceral thickness, with pelvic organ descent.

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Pelvic Floor ; Urinary Bladder ; Valsalva Maneuver ; Viscera ; Pelvic Organ Prolapse ; Urethra ; Ultrasonography ; Abdominal Cavity ; Biometry

A placental polyp is a polypoid or pedunculated mass or fragment of placental tissue retained in the uterine cavity for an indefinite period of time after abortion or partuition. These retained fragments of placental tissues, especially the hypervascular types, are common causes of vaginal bleeding in the puerperium, or occasionally, months or years after abortion or partuition, and may cause profuse hemorrhage. It is rare with an incidence of < 0.25% of all pregnancies. Despite its rarity, it is potentially life threatening, and high clinical suspicion and prompt and early diagnosis is essential, as well as an accurate diagnosis of neovascularisation to prevent hemorrhagic complications. We present four cases of hypervascular placental polypoid masses wherein thorough history taking and physical examination, in conjunction with serum ?-HCG levels and transvaginal ultrasonography with Color Doppler findings led to the prompt diagnosis of this clinical entity. Pelvic ultrasound with Doppler imaging is the most useful initial test for a suspected hypervascular lesion, because it distinguishes tissue with abundant vascularity from that with little or no blood supply. Other useful diagnostic procedures include Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) angiography. Successful conservative management of placental polypoid masses by methotrexate administration, hysteroscopic resection, and uterine artery embolization (UAE) have been reported. Hysterectomy is reserved for patients with intractable vaginal bleeding and patients who are no longer desirous of future pregnancies. Hysteroscopic resection was successfully done in two cases presented, while the other two patients underwent hysterectomy.

Human ; Female ; Adult ; Pregnancy ; Uterine Artery Embolization ; Methotrexate ; Computed Tomography Angiography ; Conservative Treatment ; Hysterectomy ; Abortion, Spontaneous ; Uterine Hemorrhage ; Postpartum Period ; Polyps ; Early Diagnosis