ORCID Profile
0000-0002-4454-0653
Current Organisations
UNSW Sydney
,
Royal Women's Hospital
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Publisher: Wiley
Date: 03-2018
DOI: 10.1002/UOG.17537
Abstract: Botulinum toxin-A (BoNT-A) is used in the treatment of pelvic floor muscle overactivity associated with chronic pelvic pain (CPP) when conservative methods such as physiotherapy are not effective or appropriate. Traditional injection techniques require finger-guided palpation of pelvic floor muscles with concurrent insertion of the needle. The aim of this study was to describe a novel technique for the injection of BoNT-A into the pelvic floor musculature using four-dimensional ultrasound (4D-US) guidance. Thirty-one BoNT-A injections were performed using the new technique between October 2013 and January 2016, on women scheduled to have BoNT-A injection for pelvic floor muscle overactivity and CPP. The pelvic floor was assessed by 4D-US. A test injection of saline was performed to confirm location of the needle, then BoNT-A was injected into the muscle under ultrasound guidance, using 4D-US to confirm that the fluid expanded and tracked along muscle fibers. The saline test confirmed correct location of the needle following a median of 1 (range, 1-3) attempt at needle placement. In all 31 instances, satisfactory injection of BoNT-A, with 4D-US confirmation of fluid expansion within the muscle body, was performed. Injection of BoNT-A under 4D-US guidance is feasible and allows accurate placement into the target muscle in women with pelvic floor muscle overactivity associated with CPP. This technique may provide a safer alternative to finger-guided methods, owing to a lower likelihood of operator needle-stick injury. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
Publisher: Wiley
Date: 11-2018
DOI: 10.1002/UOG.19075
Abstract: To describe morphometry of the pelvic floor in a large population of nulliparous women, comparing those with and those without pelvic pain. We also aimed to assess its association with characteristics such as age and body mass index (BMI). This was a prospective study performed between January 2013 and November 2015 in non-pregnant nulliparous women attending a general gynecology clinic. Following collection of demographic data, women were examined using translabial four-dimensional (4D) ultrasound. Dynamic volumes of pelvic floor muscle were obtained at rest, on maximal contraction and on Valsalva maneuver, and analyzed at a later date by an assessor blinded to demographic details. Standard measurements for each volume included levator hiatal area and anteroposterior and transverse diameters, and pubovisceral muscle length and width. Subanalysis was performed comparing women with and those without pelvic pain. Linear regression analysis was performed to assess the association between characteristics, including age and BMI, and levator hiatal area at rest. Three hundred and sixty eight nulliparous women were examined using translabial 4D ultrasound. Median levator hiatal area was 10.62 cm Pelvic floor morphometry in nulliparous women is unchanged by pelvic pain, but levator hiatal area is increased in women with higher BMI and age. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
Publisher: Wiley
Date: 17-11-2021
DOI: 10.1002/NAU.24833
Abstract: The objective of this study was to provide follow‐up data on four‐dimensional ultrasound (4DUS) morphometry for women having botulinum toxin type A (BoNT‐A) treatment of pelvic floor tension myalgia (PFTM). A prospective cohort study was performed from October 2013 to June 2018, recruiting women scheduled for BoNT‐A injection in the pelvic floor musculature. Translabial 4DUS, vaginal pressure assessment by manometry and pain visual analog scales (VAS) were performed on all women before injection and again at 4, 12, and 26 weeks. The BoNT‐A injection was performed under 4DUS guidance. Twenty‐nine women had 44 injections over the course of the study. Although improvements were seen in VAS scores for dysmenorrhea, nonmenstrual pelvic pain, and dyspareunia, there were no significant differences in ultrasound biometry at either rest, Valsalva, or on contraction when comparing postinjection measurements at 4, 12, and 26 weeks with pre‐injection baseline. Similarly, vaginal pressure readings at rest demonstrated a significant improvement throughout the 4, 12, and 26 week follow‐up, with a reduction in maximal contraction at 4 and 12 but not 26 weeks. This study demonstrates that 4DUS biometry of the pelvic floor does not correlate with clinical pain and vaginal pressure outcomes for BoNT‐A injection in the context of PFTM.
No related grants have been discovered for Erin Nesbitt-Hawes.