The use of forceps, a prolonged second stage, and obstetric anal sphincter tears were associated with levator avulsion. There were no associated intrapartum predictors for hiatal overdistension.
Both levator avulsion (macrotrauma) and irreversible overdistension (microtrauma) are associated with reduced contractile function. This effect is more easily detected by palpation than by sonographic indices of levator function.
Objective Vaginal childbirth may result in levator ani injury secondary to overdistension during the second stage of labour. Other injuries include perineal and anal sphincter tears. Antepartum use of a birth trainer may prevent such injuries by altering the biomechanical properties of the pelvic floor. This study evaluates the effects of Epi-No â use on intrapartum pelvic floor trauma.Design Multicentre prospective randomised controlled trial.Setting Two tertiary obstetric units in Australia.Population Nulliparous women carrying an uncomplicated singleton term pregnancy.Methods Participants were assessed clinically and with 4D translabial ultrasound in the late third trimester, and again at 3-6 months postpartum. Women randomised to the intervention group were asked to use the Epi-No â device from 37 weeks of gestation until delivery.
The short- to medium-term repeatability of translabial ultrasound measures of functional pelvic floor anatomy seems to be high. Hiatal area on Valsalva (ballooning) and diagnosis of levator avulsion were the most repeatable measures. The least repeatable measures related to the posterior compartment.
Both symptoms of OD and anatomical abnormalities of the posterior compartment are highly prevalent in urogynecological patients. Ultrasound findings of a true rectocele and rectal intussusception are significantly associated with obstructed defecation.
Qualitative analysis of slices on TUI and a method using LUG measurement show good agreement for the diagnosis of avulsion. The LUG method is at least equally as valid in its capacity to predict significant prolapse on clinical examination and US, as well as ballooning of the levator hiatus.
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