Introduction and hypothesis: We tested inter/intra-observer reproducibility of ten different three-D ultrasound (3D-US) pelvic floor variables and endopelvic vascularization using 3D-power Doppler angiography (3D-PDA) as a reliable method to assess pelvic floor status during pregnancy and puerperium. We hypothesized that the method would show good reproducibility. Materials and methods: A prospective study was conducted in two university hospitals, with 162 nulliparous pregnant women evaluated at weeks 12, 28 and 36, and at 48 hours postpartum and three months post-delivery. At each visit, we performed transperineal 3D-US and 3D-PDA of the pelvic floor. Images corresponding to 30 cases were electronically sent between the 2 observers to test the reproducibility of the results. Results: Correlation coefficients > 0.70 for all 10 variables were obtained. Intra-observer reproducibility for each observer was very good, with intra-class correlation coefficients > 0.86. Inter-observer reproducibility of urethral sphincter volume and vascularization, 3D-PDA, VI, FI and VFI measured by VOCAL technique with automatic threshold mode showed good correlation (ICC > 0.80), considered sufficiently high to be clinically applicable. Conclusions: The present study showed good reproducibility and high inter-and intra-observer correlation coefficients for all the variables used to assess the pelvic floor during normal pregnancy and puerperium, including vaginal anterior wall anchors (AWA) as new biometric measures. This makes them reliable parameters for diagnosis and monitoring of pelvic floor disorders in normal pregnancies. We found that use of the VOCAL technique with automatic threshold mode for measurements was superior to the manual mode due to its accuracy and shorter time requirement.

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Introduction and hypothesis: We studied ten different three-dimensional ultrasound (3D-US) and three-dimensional Power-Doppler angiography (3D-PDA) variables to assess female pelvic floor status and endopelvic vascularization. We hypothesize that 3D-US is a reliable method to determine and evaluate changes occurring in the pelvic floor during normal pregnancy and puerperium, and can be used by any urogynecology specialist with US-imaging experience. We aimed to validate this method for clinical application. Materials and methods: We performed a prospective study of 162 nulliparous pregnant women evaluated at weeks 12, 28 and 36, and at 48 hours postpartum and three months post-delivery. At each of the five visits, we performed transperineal 3D-US of the pelvic floor and 3D-PDA to assess periurethral vascularization. Results: Quantification of the vaginal anterior vaginal wall anchors (AWA) is an anthropometric parameter sensitive to changes in pregnancy and puerperium. Significant differences in AWA were observed according to delivery mode, being lower in vaginal deliveries than cesarean sections and even lower in prolonged labor deliveries and those in which episiotomy was performed. Posterior uretrovesical angle (UVA) increased during pregnancy, partially recovering after delivery although less so in those with epidural analgesia. Urethral sphincter volume (USV) decreased significantly during labor and postpartum. Periurethral vascularization increased during pregnancy and decreased significantly after delivery. Levator hiatus area (LHA) increased during pregnancy and decreased after delivery. Patients who received epidural analgesia and oxytocin showed better LHA recovery. Prolonged labor and greater fetal head circumference increased LHA. The anorectal angle (ARA) increased during pregnancy and decreased postpartum. Conclusion: All 3D-US variables and their changes during pregnancy, childbirth and the postpartum period are measurable using the Virtual Computer-Aided Analysis (VOCAL method) with automatic threshold, which is more reliable and faster for measuring USV. AWA as an important new biometric parameter should be included in the study of the pelvic floor.