Ultrasonographic Study Of Female Perineal Body Morphology And Its Supportive Function On Pelvic Floor

ObjectiveTo observe the morphology of female perineal body(PB)and analyze the elastic function,using two-dimensional ultrasound,three-dimensional reconstruction technique and shear wave elastography.Then,with the application of pelvic floor ultrasound,to conduct the study of the relationship between morphological parameters,functional parameters and pelvic organ position,levator hiatus(LH)parameters,in order to provide imaging support in the supportive function of PB for pelvic floor.MethodsA total of 258 women in our hospital were selected in this study,there were 49 nulliparous women,68 parous women without pelvic organ prolapse(POP),68 women with POP and 73 postpartum women who delivered within 42-50 days.All women were performed ultrasound examination to obverse and measure morphological parameters and Young’s modulus of PB at rest,on contraction and on Valsalva.Three-dimensional reconstruction technique was performed to establish a volume model of PB.Then,transperineal pelvic floor ultrasound was performed to evaluate the pelvic organ position and LH parameters.Furthermore,conduct preliminary study on the relationship between PB morphological parameters,Young’s modulus and pelvic organ position,LH parameters.ResultsPerineal body on the sonogram was a high-echo wedge-shaped structure between posterior vaginal wall and anorectal junction.The head was adjacent to rectovaginal septum,the tail was adjacent to perineal skin,the anterior wall was adjacent to posterior vaginal wall,and the posterior wall was adjacent to anorectal junction.Three-dimensional ultrasound can reconstruct an intuitive three-dimensional volume model of perineal body.The morphological parameters of perineal body were different at rest,on contraction and on Valsalva.The depth becomes larger and the height becomes larger on contraction,the depth becomes larger and the height becomes smaller on Valsalva.The morphological parameters of PB in the postpartum group were larger than other groups.Further analysis showed that there was no difference in the contractility of perineal body among four groups,and extensibility was larger in POP group and the postpartum group.Young’s modulus of PB was different at rest,on contraction and on Valsalva.The Young’s modulus on contraction was the largest,the one at rest was the smallest.There were differences in the Young’s modulus of PB in different groups,Young’s modulus of nulliparous group was larger than other groups.Pelvic organ positions changed significantly in POP group and postpartum group.The mobility of bladder and anorectal junction in POP group were correlated with PB,and the correlation coefficients were 0.314 and 0.456.There was no significant correlation between cervix and PB mobility.The mobility of bladder,cervix and anorectal junction in the postpartum group were all correlated with PB,with correlation coefficients of 0.595,0.517 and 0.646.The parameters of LH could not be influenced by the changes of PB morphological parameters and elastic parameters.ConclusionsUltrasound imaging techniques are convenient and intuitive method for evaluating morphological and elastic characteristics of PB.The morphological parameters and Young’s modulus of PB were different in groups,the morphological parameters were larger in the postpartum group and the Young’s modulus was larger in the nulliparous group.The change of PB position was most consistent with anorectal junction,PB had the most significant support for the posterior pelvic floor.The morphological and functional changes of PB had no significant effect on the parameters of LH.