-
Články
Top novinky
Reklama- Vzdělávání
- Časopisy
Top články
Nové číslo
- Témata
Top novinky
Reklama- Kongresy
- Videa
- Podcasty
Nové podcasty
Reklama- Kariérní portál
Doporučené pozice
Reklama- Praxe
Top novinky
ReklamaImpact of selected dimensions of pelvic floor structures on the process of delivery – a review of the literature
Authors: M. Dostalová 1
; S. Tvarožek 1
; M. Szypulová 1
; A. Šteflová 1
; M. Huser 1
; L. Hruban 1,2
Authors place of work: Klinika gynekologie, porodnictví a neonatologie LF MU a FN Brno 1; Ústav zdravotních věd, LF MU, Brno 2
Published in the journal: Ceska Gynekol 2026; 91(2): 148-156
Category: Přehledová práce
doi: https://doi.org/10.48095/cccg2026148Summary
Muscular and connective tissue structures of the pelvic floor play a crucial role throughout a woman‘s life, exerting significant influence on the course of childbirth. Injury to these soft tissues during delivery can substantially affect a woman‘s postpartum quality of life. In recent years, research has increasingly focused on evaluating pelvic floor structures prior to labor to determine whether functional or anatomical changes contribute to the labor process and its outcomes. Transperineal ultrasound has emerged as a promising tool for objectively assessing the preparedness of pelvic floor musculature for vaginal delivery. This paper summarizes current scientific evidence on the use of transperineal ultrasound in the assessment of selected dimensions of pelvic floor structures and their impact on labor progression. Several studies have demonstrated that significantly reduced dimensions of the genital hiatus are significantly associated with an increased risk of operative delivery and a prolonged second stage of labor. In the future, transperineal ultrasound may help identify women with an elevated risk of delivery-related complications. Such identification could support individualized strategies to mitigate these risks or guide the selection of the most appropriate mode of delivery, considering other clinical and obstetric factors. However, at present, pelvic floor assessment via transperineal ultrasound cannot be considered as a standalone marker for determining optimal delivery strategy. Childbirth remains a multifactorial process, and pelvic floor morphology represents only one of many variables influencing its course. Further research is needed to validate the clinical utility of this method and to establish its role in obstetric decision-making.
Keywords:
pelvic floor – delivery – caesarean section – pregnancy – ultrasonography – vacuum extraction
Zdroje
1. Caudwell-Hall J, Atan IK, Rojas RG et al. Atraumatic normal vaginal delivery: how many women get what they want? Am J Obstet Gynecol 2018; 219 (4): 379.e1–379.e8. doi: 10.1016/j.ajog.2018.07.022.
2. Youssef A, Montaguti E, Sanlorenzo O et al. Reliability of new three-dimensional ultrasound technique for pelvic hiatal area measurement. Ultrasound Obstet Gynecol 2016; 47 (5): 629–635. doi: 10.1002/uog.14933.
3. van Veelen GA, Schweitzer KJ, van Hoogenhuijze NE et al. Association between levator hiatal dimensions on ultrasound during first pregnancy and mode of delivery. Ultrasound Obstet Gynecol 2015; 45 (3): 333–338. doi: 10.1002/uog.14649.
4. Dietz HP. Pelvic floor ultrasound: a review. Am J Obstet Gynecol 2010; 202 (4): 321–334. doi: 10.1016/j.ajog.2009.08.018.
5. Youssef A, Brunelli E, Montaguti E et al. Transperineal ultrasound assessment of maternal pelvic floor at term and fetal head engagement. Ultrasound Obstet Gynecol 2020; 56 (6): 921–927. doi: 10.1002/uog.21982.
6. Dietz HP, Shek C, Clarke B. Biometry of the pubovisceral muscle and levator hiatus by three-dimensional pelvic floor ultrasound. Ultrasound Obstet Gynecol 2005; 25 (6): 580–585. doi: 10.1002/uog.1899.
7. Lakovschek IC, Trutnovsky G, Obermayer--Pietsch B et al. Longitudinal study of pelvic floor characteristics before, during, and after pregnancy in nulliparous women. J Ultrasound Med 2022; 41 (1): 147–155. doi: 10.1002/jum.15689.
8. Guntiñas A, Galocha C, Madurga R et al. Application of pelvic floor ultrasound during pregnancy to detect patients at risk of cesarean section due to failure of labor progression in a Spanish population. Eur J Obstet Gynecol Reprod Biol 2022; 269 : 102–107. doi: 10.1016/ j.ejogrb.2021.12.025.
9. Siafarikas F, Stær-Jensen J, Hilde G et al. Levator hiatus dimensions in late pregnancy and the process of labor: a 3 - and 4-dimensional transperineal ultrasound study. Am J Obstet Gynecol 2014; 210 (5): 484.e1–484.e7. doi: 10.1016/ j.ajog.2014.02.021.
10. Bjerkholt FF, Nyhus MØ, Mathew S et al. Are levator hiatal dimensions in mid-pregnancy associated with mode of delivery? Int Urogynecology J 2022; 33 (12): 3529–3534. doi: 10.1007/s00192-022-05111-x.
11. Youssef A, Del Magno A, Nedu B et al. Feasibility and reproducibility of new technique for measurement of transverse diameter of levator ani muscle hiatus using two-dimensional transperineal ultrasound in nulliparous women with term pregnancy. Ultrasound Obstet Gynecol 2024; 63 (3): 824–832. doi: 10.1002/uog.27595.
12. Örnö AK, Dietz HP. Levator co-activation is a significant confounder of pelvic organ descent on Valsalva maneuver. Ultrasound Obstet Gynecol 2007; 30 (3): 346–350. doi: 10.1002/uog.4082.
13. Youssef A, Montaguti E, Dodaro MG et al. Levator ani muscle coactivation at term is associated with longer second stage of labor in nulliparous women. Ultrasound Obstet Gynecol 2019; 53 (5): 686–692. doi: 10.1002/uog.20159.
14. Brunelli E, Del Prete B, Casadio P et al. The dynamic change of the anteroposterior diameter of the levator hiatus under Valsalva maneuver at term and labor outcome. Neurourol Urodyn 2020; 39 (8): 2353–2360. doi: 10.1002/nau.24494.
15. Murdoch-Ward J, Nahon I, De-Vitry Smith S et al. Assessment of the bearing-down manoeuvre in pregnancy and detection of paradoxical levator ani muscle contraction using 2D transperineal ultrasound and vaginal palpation: a concurrent validity and inter-rater reliability study. BJOG 2024; 131 (6): 843–847. doi: 10.1111/1471-0528.17694.
16. Kalache KD, Dückelmann AM, Michaelis SM et al. Transperineal ultrasound imaging in prolonged second stage of labor with occipitoanterior presenting fetuses: how well does the ‘angle of progression’ predict the mode of delivery? Ultrasound Obstet Gynecol 2009; 33 (3): 326–330. doi: 10.1002/uog.6294.
17. Gilboa Y, Frenkel TI, Schlesinger Y et al. Visual biofeedback using transperineal ultrasound in second stage of labor. Ultrasound Obstet Gynecol 2018; 52 (1): 91–96. doi: 10.1002/uog.18962.
18. Preuss E, De Porto A, Zisman I et al. Visual biofeedback for shortening second stage of labor: randomized controlled trial. Ultrasound Obstet Gynecol 2024; 63 (1): 9–14. doi: 10.1002/uog.26314.
19. Sartorão Filho CI, Pinheiro FA, Prudencio CB et al. Impact of gestational diabetes on pelvic floor: A prospective cohort study with three-dimensional ultrasound during two-time points in pregnancy. Neurourol Urodyn 2020; 39 (8): 2329–2337. doi: 10.1002/nau.24491.
20. Pinheiro FA, Sartorão Filho CI, Prudencio CB et al. Pelvic floor muscle dysfunction at 3D transperineal ultrasound in maternal exposure to gestational diabetes mellitus: a prospective cohort study during pregnancy. Neurourol Urodyn 2022; 41 (5): 1127–1138. doi: 10.1002/nau.24927.
21. Raimondo D, Youssef A, Mabrouk M et al. Pelvic floor muscle dysfunction on 3D/4D transperineal ultrasound in patients with deep infiltrating endometriosis: a pilot study. Ultrasound Obstet Gynecol 2017; 50 (4): 527–532. doi: 10.1002/uog.17323.
22. Mabrouk M, Raimondo D, Del Forno S et al. Pelvic floor muscle assessment on three - and four-dimensional transperineal ultrasound in women with ovarian endometriosis with or without retroperitoneal infiltration: a step towards complete functional assessment. Ultrasound Obstet Gynecol 2018; 52 (2): 265–268. doi: 10.1002/uog.18924.
23. Hájková Hympánová L, Putniková I, Zapletal J et al. Musculus levator ani coactivation and its possible impact on musculus levator ani postpartum (conference abstract). XVII EUGA Annu Meet 2024, Prague.
Štítky
Dětská gynekologie Gynekologie a porodnictví Reprodukční medicína
Článek vyšel v časopiseČeská gynekologie
Nejčtenější tento týden
2026 Číslo 2- I „pouhé“ doporučení znamená velkou pomoc. Nasměrujte své pacienty pod křídla Dobrých andělů
- Postabortivní syndrom – opomíjená posttraumatická stresová porucha
- Lidský anti-D imunoglobulin (přípravek RHESONATIV) dostupný na českém trhu
- S doc. Tomášem Faitem o aktuálních trendech a nových možnostech terapie chronických vulvovaginitid
- Léčba perzistentní epistaxe u pacienta s von Willebrandovou chorobou typu 2A – kazuistika
-
Všechny články tohoto čísla
- vNOTES hysterektomie snižuje míru laparotomie u obezity III. stupně – retrospektivní srovnávací studie
- Perinatální výsledky u těžké preeklampsie s peritoneálním ascitem – zkušenosti z jednoho terciárního centra
- Epidemiologie obezity v těhotenství v České republice – demografické souvislosti a klinické dopady
- Endometriom Bartholinovy žlázy
- Vulvodynie a perzistentní vulvární bolest – diagnostika, terapie a role laserové vaporizace
- Klinicky významné histopatologické charakteristiky a biomarkery karcinomu endometria
- Limity skríningu a prevencie preeklampsie v populácii žien po metódach asistovanej reprodukcie
- Vliv vybraných rozměrů struktur pánevního dna na průběh porodu – přehled literatury
- Doporučení ESGO/ISUOG pro jehlové biopsie v onkogynekologii – upravená verze
- Zemřel doc. MUDr. Jaroslav Feyereisl, CSc. – bývalý ředitel Ústavu pro péči o matku a dítě
- Vliv angiogenních faktorů a mateřské endoteliální dysfunkce na výsledek těhotenství
- Kryokonzervace oocytů pro zachování ženské plodnosti
- Česká gynekologie
- Archiv čísel
- Aktuální číslo
- Informace o časopisu
Nejčtenější v tomto čísle- Vliv angiogenních faktorů a mateřské endoteliální dysfunkce na výsledek těhotenství
- Vliv vybraných rozměrů struktur pánevního dna na průběh porodu – přehled literatury
- Kryokonzervace oocytů pro zachování ženské plodnosti
- Perinatální výsledky u těžké preeklampsie s peritoneálním ascitem – zkušenosti z jednoho terciárního centra
Kurzy
Zvyšte si kvalifikaci online z pohodlí domova
Revma Focus: Spondyloartritidy
nový kurz
Autoři: prof. MUDr. Vladimír Palička, CSc., Dr.h.c., doc. MUDr. Václav Vyskočil, Ph.D., MUDr. Petr Kasalický, CSc., MUDr. Jan Rosa, Ing. Pavel Havlík, Ing. Jan Adam, Hana Hejnová, DiS., Jana Křenková
Autoři: MDDr. Eleonóra Ivančová, PhD., MHA
Autoři: prof. MUDr. Eva Kubala Havrdová, DrSc.
Všechny kurzyPřihlášení#ADS_BOTTOM_SCRIPTS#Zapomenuté hesloZadejte e-mailovou adresu, se kterou jste vytvářel(a) účet, budou Vám na ni zaslány informace k nastavení nového hesla.
- Vzdělávání