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The goal of this study was to evaluate normal hiatal dimensions in the third trimester in nulliparous Thai pregnant women and to establish which biometric factors were associated with various pregnancy outcomes. Fifty-seven consecutive nulliparous pregnant Thai women in their third trimester were recruited on a voluntary basis from April to October 2014. All subjects underwent four-dimensional (4D) translabial ultrasonography. Hiatal biometric parameters were measured at rest, while performing a Valsalva maneuver, and during contraction. Information about the patients' eventual deliveries was obtained from their medical records. The mean values of the patients' age, body mass index, and gestational age at the time of examination were 27.4±5.47 years, 26.7±3.48 kg/m(2), and 36.6±1.49 weeks, respectively. No subjects had vaginal lumps or experienced prolapse greater than stage 1 of the Pelvic Organ Prolapse Quantification system. Ultrasonography showed that the mean values of the hiatal area at rest, while performing a Valsalva maneuver, and during contraction were 13.10±2.92 cm(2), 17.50±4.81 cm(2), and 9.69±2.09 cm(2), respectively. The hiatal area at rest, the axial measurement at rest, and the axial measurement while performing a Valsalva maneuver were significantly associated with the route of delivery (P=0.02, P=0.04, and P=0.03, respectively). The route of delivery was associated with hiatal biometric values measured using 4D translabial ultrasonography, based on the results of nulliparous Thai women in the third trimester.

Introduction and hypothesis The aim of this study was to determine associations between the ultrasonic appearance of Monarc suburethral slings and postoperative bladder symptoms at an average follow-up time of 11 months. Methods A prospective clinical audit was conducted on 98 patients after Monarc suburethral sling. The assessment included pelvic floor ultrasound to determine the gap between the sling and symphysis pubis, the angle formed by cranial and caudal ends of the sling at rest and on Valsalva, and the location of the sling relative to the urethra. Results Patients who reported postoperative stress incontinence (SI) or urge incontinence (UI) had a significantly wider gap between the symphysis pubis and sling ( P  = 0.032 and P  = 0.006, respectively). Conclusions A narrower gap between the tape and symphysis pubis is associated with both SI and UI cure. Tighter transobturator sling placement seems to be advantageous for the cure of both SI and UI.

Introduction and hypothesis The perineal body is an important structure which is often injured during labor. It is believed to play a role in pelvic organ support. Vaginal delivery is likely to increase the mobility of perineal body and anorectal junction. The aim of this study was to determine changes in the mobility of perineal body and anorectal junction before and after delivery using pelvic floor ultrasound. Methods Two hundred nulliparous women were enrolled and underwent pelvic floor ultrasound at 36–38 weeks gestation and 3–6 months postpartum. Levator hiatal dimensions and mobility of the perineal body and anorectal junction were measured in volume ultrasound datasets using postprocessing software, blinded against all clinical data, before and after childbirth. Results Ultrasound measures of mobility of perineal body and anorectal junction were shown to be reproducible (ICC 0.74 and 0.76). After delivery, mobility of both structures had increased significantly (both P  < 0.001), and postpartum perineal mobility was associated with delivery mode ( P  = 0.015). A significant correlation was found between these outcome measures and levator hiatal area on Valsalva, both before and after delivery. Perineal trauma, episiotomy, epidural block, augmentation of labor, and length of first and second stage of labor were not associated with postpartum mobility of perineal body and anorectal junction. Conclusions Vaginal delivery increases the mobility of perineal body and anorectal junction. Perineal mobility may be partly determined by distensibility of the levator hiatus.

Introduction and hypothesis The purpose of this study is to evaluate whether antepartum use of a birth trainer may reduce levator trauma. Methods Two hundred nulliparous women were examined with four-dimensional translabial ultrasonography at 35–37 weeks of gestation and 3 months postpartum in a randomised controlled pilot study. Women in the intervention group were instructed to use the birth trainer from 37 weeks onwards. Results One hundred forty-six women returned for follow-up 5.6 months (range 2.3–22.1) after childbirth. Seventy-eight of them had had normal vaginal deliveries (53%), 32 vacuum/forceps (22%) and 36 a caesarean section (25%). The risk of avulsion was halved in the intervention group (6% vs 13%, P  = 0.19) on modified intention to treat analysis. A treatment received analysis revealed a nonsignificant 42% and 30% reduction in levator avulsion and microtrauma, respectively ( P  ≥ 0.22). Conclusions This pilot randomised controlled trial showed a nonsignificantly lower incidence of pelvic floor muscle injury in women who used the Epi-No® device from 37 weeks onwards.