Evaluating Z Scores to Quantify Levator Hiatal Distensibility by 3‐Dimensional Ultrasonography in Nulliparas and Women With Pelvic Organ Prolapse. (12th March 2018)

• Record Type: Journal Article
• Authors: Wen, Lieming; Liu, Minghui; Zhao, Baihua; Qing, Zhenzhen
• Is Part Of: Journal of ultrasound in medicine. Volume 37:Number 10(2018)
• Page Start: 2363
• Page End: 2369
• Publication Date: 2018-03-12
• Subjects: hiatal ballooning -- levator hiatus -- pelvic floor -- pelvic organ prolapse -- 3‐dimensional ultrasonography -- Z score; Ultrasonics in medicine -- Periodicals; Ultrasonics; Ultrasonography; Ultrasonics in medicine; Electronic journals; Periodicals; Periodicals; 616.07543
• DOI: 10.1002/jum.14590
• Languages: English
• ISSNs: 0278-4297

Abstract

Abstract : Objectives: To use Z scores to quantify hiatal distensibility and to test the performance of Z scores for levator hiatal areas in predicting substantial pelvic organ prolapse (POP). Methods: We undertook a retrospective study of the data from 145 nulliparas and 166 patients with POP who had a clinical POP examination with 3‐dimensional translabial ultrasonography. Z scores were used to normalize levator hiatal areas of nulliparas. The Z score model for the hiatal area was built by the formula Z score = (measured value – predicted mean value)/predicted standard deviation and was used to evaluate hiatal ballooning in women with POP. Results: Valid data were gathered from 134 nulliparas and 159 patients with POP. POP stage 1 was found in 46 women, stage 2 in 62, stage 3 in 43, and stage 4 in 8. We built the Z score model as follows: Z ‐Av = (measured value – 17.15)/3.11, where Av represented the minimal levator hiatal area on the maximum Valsalva maneuver. The levator hiatal area was strongly related to the POP stage ( P < .001). On a receiver operating characteristic curve analysis, the cutoff of Z ‐Av was 1 for POP stage 2 or higher (sensitivity, 77%; specificity, 60%) and substantial POP on ultrasonography (sensitivity, 84%; specificity, 75%). Conclusions: Hiatal distensibility can be exactly evaluated by Z ‐Av. A Z ‐Av value of less than 1.0 was defined as a "normal hiatal expansion, " 1 to 3 as "mild ballooning, " 3 to 5 as "moderate ballooning, " 5 to 7 as "marked ballooning, " and 7 or greater as "severe ballooning."