Persistence of levator ani sonographic defect detected by three-dimensional transperineal sonography in primiparous women

D. V. Valsky, M. Lipschuetz, S. M. Cohen, H. Daum, B. Messing, I. Yagel, S. Yagel

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


Objectives Correlation of the sonographic appearance of levator ani muscle (LAM) injury soon after delivery with that at long-term follow-up has not been described fully. We aimed to compare results of three-dimensional (3D) transperineal sonographic (TPS) evaluation of the LAM from the period immediately postpartum with long-term follow-up, to determine whether sonographic findings persist over time. Methods Primiparous women (n = 210) who had been examined by 3D-TPS in a previous study to determine LAM trauma 24-72 hours after delivery were invited to participate in a follow-up examination 3-21 months postpartum. We included in this study only women who were not pregnant when approached and who had not given birth in the interim. LAM trauma was diagnosed with 3D-TPS when we observed discontinuity and distortion of the most anteromedial part of the pubovisceral muscle in the coronal C-plane or rendered image. Initial and follow-up 3D-TPS results were compared using Cohen's kappa test for inter-rater agreement. Results Among the 87 women included in this study we found strong correlation between earlier and later sonographic appearance of LAM: 17/21 women with a sonographic finding of LAM injury in the period immediately postpartum were positive in the follow-up examination, and only 2/66 women negative for LAM damage at the first examination were found to have sonographic evidence of LAM defect at follow-up (Cohen's kappa, 0.805 (95% CI, 0.656-0.954), P < 0.001). Conclusions Our findings suggest that 3D-TPS of the LAM is a reliable examination. A sonographic finding of LAM defect identified in the period immediately postpartum persists months or years after delivery; therefore, this test may be performed following delivery, or may be delayed without impacting the result. It is likely that this sonographic defect represents real anatomical disruption and is not an imaging artifact.

Original languageEnglish
Pages (from-to)724-729
Number of pages6
JournalUltrasound in Obstetrics and Gynecology
Issue number6
StatePublished - 1 Dec 2015
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2015 ISUOG. Published by John Wiley & Sons Ltd.


  • 3D-TPS
  • 3D-TUS
  • LAM avulsion
  • levator ani muscle


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