Operative vaginal delivery was a risk factor for levator injury in women with OASIs, and levator injury was associated with a weaker pelvic floor muscle contraction. Special attention is recommended for women with OASI and levator injury as they would be at high risk of future pelvic floor disorders. The benefits of implementation of an intensive, focused and structured pelvic floor rehabilitation program needs to be evaluated in these women. This article is protected by copyright. All rights reserved.

Although bladder neck and urethral mobility increased from pregnancy to 4 years postpartum irrespective of delivery mode, women with LAM injury had larger increase in BND, suggesting that this is important in the pathogenesis of bladder neck mobility and could lead to pelvic floor dysfunction in the long term.

Introduction and hypothesis Our aim was to explore the association between anal incontinence (AI) and persistent anal sphincter defects diagnosed with 3D endoanal (EAUS), introital (IUS) and transperineal ultrasound (TPUS) in women after obstetric anal sphincter injury (OASI) and study the association between sphincter defects and anal pressure. Methods We carried out a cross-sectional study of 250 women with OASI recruited during the period 2013-2015. They were examined 6-12 weeks postpartum or in a subsequent pregnancy with 3D EAUS, IUS and TPUS and measurement of anal pressure. Prevalence of urgency/solid/liquid AI or flatal AI and anal pressure were compared in women with a defect and those with an intact sphincter (diagnosed off-line) using Chi-squared and Mann-Whitney U test. Results At a mean of 23.6 (SD 30.1) months after OASI, more women with defect than those with intact sphincters on EAUS had AI; urgency/solid/liquid AI vs external defect: 36% vs 13% and flatal AI vs internal defect: 27% vs 13%, p < 0.05. On TPUS, more women with defect sphincters had flatal AI: 32% vs 13%, p = 0.03. No difference was found on IUS. Difference between defect and intact sphincters on EAUS, IUS and TPUS respectively was found for mean [SD] maximum anal resting pressure (48 [13] vs 55 [14] mmHg; 48 [12] vs 56 [13] mmHg; 50 [13] vs 54 [14] mmHg) and squeeze incremental pressure (33 [17] vs 49 [28] mmHg; 37 [23] vs 50 [28] mmHg; 36 [18] vs 50 [30] mmHg; p < 0.01). Conclusions Endoanal ultrasound had the strongest association with AI symptoms 2 years after OASI. Sphincter defects detected using all ultrasound methods were associated with lower anal pressure.

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levator ballooning between women with or without episiotomy (20 (19.4%) versus 23 (22.8%); p = 0.557) Oxytocine use was found to be a protective factor for LA (OR 0.48 (95% CI 0.234-0.990) p = 0.047). The duration of the second stage of labour increased the risk for LA (OR 1.01 (95% CI 1.001-1.028). Non occiput anterior fetal position increased the risk for ballooning and for pelvic floor injuries (OR 10.38 (95% CI 1.87-57.66) and OR 11.01 (95% CI 1.26-96.03). There were neither differences in urogynecological complaints between women with or without episiotomy nor between women with or without pelvic floor injuries.Interpretation of results: Pelvic floor injury is related with a prolonged second stage of labor, but not with episiotomy.Conclusions: Episiotomy has no influence in developing pelvic floor injuries or urogynecological complaints. References[1] Kapoor DS, Thakar R, Sultan AH. Obstetric anal sphincter injuries: review of anatomical factors and modifiable second stage interventions. Int Urogynecol J 2015 Dec;26(12):1725-34. [2] Verghese TS, Champaneria R, Lapoor DS, Latthe PM. Obstetric anal sphincter injuries after episiotomy: systematic review and meta-analysis. Int Urogynecol J The effect of a mediolaterale episiotomy during operative vaginal delivery on the risk of developing obstetrical anal sphincter injuries. Am J Obstet Gynecol 2012 May;206(5):404.