Are there differences in the damage to the pelvic floor between malmstrom's and kiwi omnicup vacuums? A multicenter study

Abstract

Objectives: The objective of this study is to investigate a multicenter study to establish if differences exist in the levator ani muscle avulsion (LAM) rates between deliveries performed with Malmstrom's vacuum and the Kiwi vacuum. Study design:A prospective, multicenter observational study with 199 primiparous subjects was performed. All patients had undergone vaginal delivery by vacuum (Malmstrom's or Kiwi). Avulsion was defined as an abnormal insertion of LAM in the lower pubic branch in the multiplanar mode, as identified in the three central sections by transperineal 3/4D echography 6 months after delivery. The area of the levator hiatus was measured in the plane of minimum dimensions at rest, during the Valsalva maneuver and during contraction.Results: LAM avulsion occurred in 33.1% of cases in which Malmstrom's vacuum was used and in 29.4% of cases in which the Kiwi vacuum was used (the difference was not statistically significant), which resulted in a crude odds ratio (OR) of 0.977 (0.426, 2.241; P = .957) and an adjusted OR of 2.90 (0.691; 12.20; P = .146). Women in the Malmstrom's vacuum group had a larger LHA at rest 14.77 vs 12.64 cm 2 ; P = .001) and at maximum contraction (13.41 vs 10.83 cm 2 ; P < 0.001) in comparison with the Kiwi group, although the difference did not reach statistical significance under Valsalva maneuver (18.71 vs 17.21 cm 2 ; P = .051).Differences between both groups were detected in the measurements of the hiatus area levator at rest (14.77 vs 12.64 cm 2 ), during the Valsalva maneuver (18.71 vs 17.21 cm 2 ) and during maximum contraction (13.41 vs 10.83 cm 2 ). Conclusions:In the present study, Malmstrom's vacuum was not associated with a higher risk of LAM in comparison with Kiwi's Omnicup. K E Y W O R D Skiwi omnicup vacuum, levator ani muscle, malmstrom's vacuum, pelvic floor, ultrasound

Association between the side of levator Ani muscle trauma and fetal position at birth – a prospective observational study

“…The total rate of partial and complete avulsions after vaginal birth in our study was 23.9 %. This rate is consistent with the rates reported in other studies [1][2][3][4][5][6][7]. Furthermore, we found LAM hematomas in 9.4 % of women.…”

“…Pelvic floor trauma after childbirth is a current topic of high interest and focus in current obstetrical research as women grow more and more concerned about their physical wellbeing and body integrity after vaginal birth. Trauma of the pelvic floor occurs mainly during the very first birth and often results in a widened genital hia tus or in a partial or complete avulsion of the levator ani muscle (LAM) in 6-63 % of cases [1][2][3][4][5][6][7][8][9]. These LAM avulsions can most reliably be diagnosed by 3-dimensional (3D) translabial ultrasound (TLUS), as described by Dietz et al [10][11][12][13].…”

Comparison of Maternal-Fetal Outcome Following Operative Delivery: Omnicup Versus Malmstrom Metal Cup: Clinical Research

“…The study showed that the vacuum of Malmstrom was not associated with a higher risk of LAM compared with the Omnicup of Kiwi. 18 Maternal or neonatal outcomes and failure rates did not differ between the 2 groups, but procedure time and fundal pressure maneuver were more frequent in the Malmstrom group. The authors of this study suggested that Kiwi Omnicup and Malmstrom metal cup vacuum aspirators were safe and functionally effective for vacuum assisted delivery.…”

Diagnosis of Levator Ani Muscle Avulsion in Instrumented Delivery: Meta-analysis

“…Five studies were retrospective and the rest prospective. The ultrasound examination was performed in most studies within 6 months after delivery [11][12][13][14][15][16][17]19,20,22,23,[25][26][27][28][29][30][31][32][33][34][35], though some performed an ultrasound examination only or also after this period [17,18,21,24,35,36]. Some papers included a small number of VDs [12,20,27] and FDs [12][13][14]27], a possible source of bias.…”

“…The type of instrument used during delivery was not reported in 13 studies with VD [11][12][13][15][16][17][18][20][21][22][23]27,35] and in 10 with FD [11][12][13][14][15][16]18,21,23,27]. The majority of articles that specified the type of vacuum used in the RV reported that a metal vacuum bird's cup was 50 mm [19,[24][25][26]29,30,[32][33][34], although one of them also assessed LAM avulsion after a Kiwi vacuum was used [32]. The majority of studies on FD described the rates of LAM avulsion with Kielland's forceps [28][29][30][31]33,34,36], though one of them studied Anderson forceps and Wrigley forceps [19].…”