Combined three-dimensional transperineal ultrasonography (3-D TPUS) and magnetic resonance imaging (MRI) after vaginal delivery

Abstract

Background – Unlike severe injuries, which are promptly recognized and repaired after parturition, most often occult lesions to the vagina and supporting structures go undetected until they evolve toward overt pelvic floor dysfunction at a later age. Aim – To describe a combined 3–D TPUS/MRI standard imaging protocol to be adopted routinely after vaginal delivery so as to prevent later development of pelvic organ prolapse and double incontinence. Materials and Methods – A two–step diagnostic imaging examination of the pelvic floor anatomy is obtained early within the first 2 weeks consisting of (A) 3–D TPUS assessment using volume dataset acquisition for evidence of sphincter defects, vaginal tears, and levator hiatus avulsion; and (B) static MRI of the pelvis with a 1.5–T superconductive magnet using a phased array external coil wrapped around the female pelvis for evidence of paraurethral and paravaginal support structures defects, levator ani muscle discontinuity and detachment, anovaginal fistula, and perineal body disruption. Diagnostic imaging is repeated later within 6 months with dynamic MRI on straining to rule out pelvic organs prolapse. Proper therapy (either by rehabilitation or minor surgery) is set up accordingly and results are evaluated periodically every 5 years with 3–D TPUS. Conclusions – Hopefully, significant improvement of the quality life in the general female population after vaginal delivery and reduced incidence of pelvic organ prolapse at later age is expected from adopting the US/MRI imaging protocol described above.