Can ballooning of the levator hiatus be determined clinically?

Am J Obstet Gynecol. 2012 Mar;206(3):246.e1-4. doi: 10.1016/j.ajog.2011.10.876. Epub 2011 Nov 7.


Objective: The objective of the study was to determine whether genital hiatus (gh) and perineal body (pb), measured using the pelvic organ prolapse quantification system of the International Continence Society, are predictive of an abnormally distensible levator hiatus on ultrasound and of objective prolapse and/or prolapse symptoms.

Study design: The design of the study included datasets of 188 urogynecology patients assessed in a cross-sectional retrospective study.

Results: Gh and pb, as well as gh plus pb, were strongly associated with symptoms and signs of prolapse and with hiatal area on ultrasound. The sum of gh and pb was superior in predictive performance to individual measures for symptoms (P < .001) and signs of prolapse (P < .001). Gh plus pb equaled the hiatal area on ultrasound (area under the curve, 0.886; 95% confidence interval, 0.828-0.945 vs 0.867; 95% confidence interval, 0.808-0.926) for predicting objective prolapse. Optimal sensitivity (80%) and specificity (81%) was reached with a cutoff of 7 cm for gh plus pb.

Conclusion: A cutoff of 7 cm for gh plus pb measured on Valsalva is proposed as a clinical definition of excessive levator hiatal distensibility.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • Humans
  • Imaging, Three-Dimensional / methods
  • Middle Aged
  • Muscle, Skeletal / anatomy & histology
  • Muscle, Skeletal / diagnostic imaging*
  • Muscle, Skeletal / physiopathology
  • Pelvic Floor / diagnostic imaging
  • Pelvic Organ Prolapse / diagnosis
  • Pelvic Organ Prolapse / diagnostic imaging*
  • Retrospective Studies
  • Sensitivity and Specificity
  • Ultrasonography
  • Young Adult