The Evolution of Pelvic Floor Ultrasound: From Urinary Incontinence and Pelvic Organ Prolapse to Maternal Birth Trauma, Levator Avulsion and Anal Sphincter Tears.

Ultrasound imaging has been the most important diagnostic technique in Obstetrics and Gynaecology for well over a generation. However, while it is entirely dominant in Obstetrics, this is less obvious in Gynaecology. Urogynaecology or pelvic floor medicine remains a Cinderella subject even within Gynaecology, and imaging still has only a niche existence in Urogynaecology. The latter is partly due to a lack of equipment and sometimes of reimbursement, partly due to the strong surgical orientation of the subspecialty, and partly due to simple human inertia. In regard to birth trauma, political factors such as natural childbirth ideology with its denial of maternal birth trauma, and pressure on Caesarean section rates, have delayed the utilisation of pelvic floor ultrasound, despite its obvious potential in clinical audit and practice improvement. The origins of ultrasound imaging in Urogynaecology go back nearly 50 years to a time when B mode realtime sonographic imaging using solid-state curved array transducers had just become ubiquitous in Obstetrics, impacting on antenatal care worldwide. Pelvic floor ultrasound is now changing both intrapartum care and Urogynaecology, but much work remains to be done. This contribution tries to chronicle the evolution of pelvic floor ultrasound from its inception in the mid-1980s until the present day.