title: Reliability of pelvic floor measurements on three- and four-dimensional ultrasound during and after first pregnancy: implications for training.
abstract: OBJECTIVE
  To evaluate the reliability of measurements of the levator hiatus and levator-urethra gap (LUG) using three/four-dimensional (3D/4D) transperineal ultrasound in women during their first pregnancy and 6 months postpartum, and to assess the learning process for these measurements.
  
  
  METHODS
  An inexperienced observer was taught to perform measurements of the levator hiatus and LUG by an experienced observer. After training, 3D/4D ultrasound volume datasets of 40 women in the first trimester were analyzed by these two observers. Another training session then took place and both observers repeated the analyses of the same volume datasets. Finally, analyses of 40 volume datasets of the women 6 months postpartum were performed by both observers. Intra- and interobserver reliability were determined by intraclass correlation coefficients (ICC) with 95% CIs.
  
  
  RESULTS
  For levator hiatal measurements, in the women during their first pregnancy the interobserver reliability was substantial to almost perfect after both the first and second training session (ICC, 0.62-0.83 and 0.71-0.89, respectively, for anteroposterior diameter, transverse diameter and area at rest, on contraction and on Valsalva) and the intraobserver reliability was substantial to almost perfect for both observers. For these measurements performed once the women had delivered, interobserver reliability was moderate to almost perfect. For LUG measurements performed during pregnancy, interobserver reliability was slight to moderate after the first training session (ICC, 0.14-0.54), but improved after the second training session (ICC, 0.38-0.71), and intraobserver reliability was moderate to substantial for the experienced observer and slight to moderate for the inexperienced observer. For these measurements performed when the women had delivered, interobserver reliability was fair to moderate.
  
  
  CONCLUSIONS
  The levator hiatus and LUG can be measured reliably using 3D/4D ultrasound in primigravid and primiparous women. The technique to measure dimensions of the levator hiatus requires limited teaching, but LUG measurements are more difficult and require more extensive training.
authors.affiliation: Department of Reproductive Medicine and Gynecology, University Medical Center, Utrecht, The Netherlands.
authors.forename: G A
authors.initials: GA
authors.lastname: van Veelen
authors.forename: K J
authors.initials: KJ
authors.lastname: Schweitzer
authors.forename: C H
authors.initials: CH
authors.lastname: van der Vaart
mesh_terms: D000328:Adult; D002983:Clinical Competence; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods / Q000706:statistics & numerical data*; D015588:Observer Variation; D017773:Pelvic Floor / Q000033:anatomy & histology / Q000000981:diagnostic imaging*; D011247:Pregnancy; D015203:Reproducibility of Results; D016216:Ultrasonography, Prenatal / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data*; D014636:Valsalva Maneuver / Q000502:physiology
keywords: 3D/4D ultrasound; learning process; pelvic floor; reliability; transperineal ultrasound