Introduction: The assessment of pelvic floor muscle function is crucial for managing pelvic floor dysfunctions, yet digital palpation is subjective and lacks reproducibility. This study aimed to correlate pelvic floor muscle contractility assessed by digital palpation with transperineal ultrasound measurements and evaluate the reliability of the Modified Oxford Scale and key ultrasound-derived parameters. By comparing these methods, the study sought to establish transperineal ultrasound as a reliable, objective, and non-invasive tool for assessing pelvic floor muscle contractility.
Material and methods: A cross-sectional study was conducted at Shengli Provincial Hospital from November 2019 to July 2024. 442 of 512 screened women were included. Digital palpation was performed by two independent clinicians, and ultrasound measurements were conducted by two separate raters. Ultrasound raters were blinded to palpation (Modified Oxford Scale) findings. Transperineal ultrasound quantified multiple pelvic floor parameters, including proximal urethral axis angle change (maximal contraction-rest) and levator hiatus area. Inter-rater reliability was assessed using intraclass correlation coefficients for ultrasound measures and Cohen's kappa for MOS ratings. Correlations between ultrasound and palpation scores were analyzed using Spearman's rank. Cut-off values for key ultrasound parameters corresponding to palpation grades were determined via receiver operating characteristic curve analysis.
Results: Significant correlations (p < 0.001) were found between ultrasound parameters and MOS scores, with the strongest correlations observed for proximal urethral axis angle change (maximal contraction-rest) (rs = 0.727) and proportional change in levator hiatus area (rs = 0.717). Ultrasound assessments showed high inter-rater reliability (intraclass correlation coefficient = 0.92 for proximal urethral axis angle change), while palpation demonstrated moderate agreement (Cohen's kappa = 0.55). Cut-off values for key parameters were derived, such as proximal urethral axis angle change <9.5° for absent contraction and >16.5° for strong contraction.
Conclusions: Transperineal ultrasound demonstrated high reliability and provided an objective, non-invasive method for assessing pelvic floor muscle contractility. While digital palpation assessed functional strength, ultrasound visualized structural displacement during contraction. The two methods addressed complementary aspects of pelvic floor function, and their combined use enhanced clinical assessment.
Following the COVID-19 pandemic, Northwestern Europe has experienced a marked increase in congenital parvovirus infections. This rise is attributed to social distancing measures which disrupted the usual seasonal variation of parvovirus B19. Fetal infection may cause severe anemia, thrombocytopenia, and hydrops fetalis, with significant risk of intrauterine death. Therefore, when acute parvovirus B19 infection is confirmed by maternal serology, serial ultrasound surveillance of the middle cerebral artery peak systolic velocity is recommended. Intrauterine transfusion remains the only established therapeutic option for cases of suspected fetal anemia or hydrops but carries risks of fetal loss and procedural-related complications including fetal hemorrhage and exsanguination. This review critically examines current literature on diagnosis, management, perinatal outcomes, and long-term neurodevelopmental sequelae following congenital parvovirus infection and intrauterine transfusion. Additionally, we report our tertiary fetal medicine center's experience during the 2024 epidemic, highlighting a novel conservative management approach for fetuses with parvovirus-related anemia and hydrops fetalis.
Vulvovaginal cancer in pregnancy is rare. Limited data complicate decision-making and patient counseling. Our review, coupled with new case data, fills a current gap in the literature and provides practical insights.
Oncological and obstetric data of these pregnancies were examined by a case collection from the International Network on Cancer, Infertility and Pregnancy (INCIP) registry (vulvar n = 10, vaginal n = 5) and a literature review (vulvar n = 46, vaginal n = 37).
Although preoperative imaging of inguinofemoral lymph nodes is feasible, only 16.1% of vulvar cancer patients underwent ultrasound or MRI. Treatment was initiated during pregnancy for 69.1% of vulvar cancer and 28.4% of vaginal cancer patients. Surgical lymph node staging of vulvar cancer was postponed until after delivery in 10 cases, although uni- or bilateral lymphadenectomy during pregnancy was not associated with more complications. Delivery outcomes included a live birth rate of 96.4% for vulvar cancer and 50% for vaginal cancer due to the high rate of pregnancy terminations, with most births preterm. The overall 5-year survival rates for vulvar (81.3%) and vaginal (66.4%) cancer during pregnancy are comparable to nonpregnant populations, indicating that pregnancy does not adversely impact maternal prognosis.
This study underscores the feasibility of adapting standard oncological care for pregnant patients, emphasizing multidisciplinary teams to optimize maternal and fetal outcomes.
We aimed to determine if women with a history of preterm labor successfully arrested by tocolytic treatment who gave birth at term in their previous pregnancy are at an increased risk of preterm delivery in their next pregnancy.
This case-control study included women with two consecutive singleton pregnancies who gave birth in the 15-year period of 2000–2014 at the tertiary hospital of Poissy-Saint-Germain. Cases (preterm labor [PTL] group) included all women admitted with intact membranes for preterm labor that was successfully arrested by tocolytic treatment between 24 + 0 and 34 + 6 weeks' gestation and who gave birth at term in the first of these two pregnancies. Two control groups were selected: (i) a spontaneous preterm delivery (sPTD) group including all women with a preterm delivery in the first pregnancy, and (ii) a term delivery (TD) group that included women selected among those who gave birth at term in the previous pregnancy. The primary outcome was the spontaneous preterm birth in the next pregnancy.
The PTL, sPTD, and TD groups included 114, 50, and 114 women, respectively. There were no significant differences for maternal age, body mass index, or relationship situation for both pregnancies. The mean (± SD) gestational age at the first study delivery was 39.1 (±1.2) weeks in the PTL group, 33.2 (±3.7) weeks in the PTD group, and 39.6 (±1.2) weeks in the TD group (p < 0.001 for each comparison). The delivery rate before 37 weeks of gestation in the subsequent pregnancy was 18.4% in the arrested PTL group, 34.0% in the PTB group, and 4.4% in the TD groups (p = 0.047 between arrested PTL and sPTD; p < 0,001 between arrested PTL and TD) and before 34 weeks, 6.1%, 16.0%, and 0%, respectively (p = 0.044 between arrested PTL and sPTD; p < 0,001 between arrested PTL and TD).
Women with a history of preterm labor that was successfully arrested by tocolytic treatment, resulting in a TD, are at a higher risk of preterm delivery in their next pregnancy than women with no such history, but a lower risk than those with a preterm delivery in their last pregnancy.
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