Can pelvic floor trauma be predicted antenatally?

Caudwell-Hall, Jessica; Atan, Ixora Kamisan; Brown, Chris; Rojas, Rodrigo Guzmán; Langer, Susanne; Shek, Ka Lai; Dietz, Hans Peter

doi:10.1111/aogs.13315

Cited by 25 publications

(14 citation statements)

References 34 publications

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“…A probable explanation is that episiotomy is more often used in operative vaginal delivery, which is the main risk factor for levator trauma. We also found a slight protective effect of higher BMI on LAM injury, consistent with the results of a recent study by Caudwell‐Hall et al …”

Section: Discussionsupporting

confidence: 93%

Levator ani muscle morphology and function in women with obstetric anal sphincter injury

Volløyhaug

Taithongchai

Gruting

et al. 2019

Ultrasound in Obstet & Gyne

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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.

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Section: Discussionsupporting

confidence: 93%

Levator ani muscle morphology and function in women with obstetric anal sphincter injury

Volløyhaug

Taithongchai

Gruting

et al. 2019

Ultrasound in Obstet & Gyne

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“…Women with pelvic floor damage frequently experience severe short and longterm morbidity, such as pain, a widened vagina, urine or fecal incontinence, sexual disorders, psychological distress, uterine prolapse, or the need for repetitive surgeries at immense cost to the health system [3,[14][15][16][17][18]. Common discussed risk factors for LAM avul sions are advanced maternal age, lower body mass index, a higher fetal weight and head circumference, a prolonged second stage of labor and vaginal operative deliveries, especially forceps extractions [19][20][21][22][23][24]. These factors are reported as risk factors for any kind of LAM avulsion.…”

Section: Introductionmentioning

confidence: 99%

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

Kimmich

Birri

Zimmermann

et al. 2020

Z Geburtshilfe Neonatol

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Introduction Trauma of the levator ani muscle (LAM) is common after vaginal birth and can most reliably be diagnosed by 3-dimensional (3D) translabial ultrasound (TLUS). Multiple risk factors are known in general, but not in association to a specific side of the body. Therefore, our aim was to evaluate different impact factors which cause LAM trauma on either side of the body or bilateral by focusing on the fetal position at birth. Material and Methods As part of a prospective cohort study between 3/2017 and 4/2019, we analyzed vaginal births of nulliparous women with singletons in vertex presentation≥36+0 gestational weeks. We evaluated their pelvic floor for hematomas, partial and complete LAM avulsions by 3D TLUS 2–4 days postpartum and searched for an association between the affected body side and different fetal, maternal and obstetrical factors. Results 71 out of 213 women (33.3%) suffered from LAM trauma – 17 (23.9%) on the right side, 20 (28.2%) on the left side and 34 (47.9%) bilateral. No association between the different evaluated factors and the affected body side could be identified, except for the quality of fetal heart rate tracing. Conclusions No significant impact factors of LAM trauma could be associated with a specific side of the body. Other possible mechanisms need investigation in the future, such as the time of the birth canal and the fetus to adapt to each other, including adequate time for the tissue to stretch and the fetus to rotate into the ideal position within the LAM hiatus.

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“…However, there are other factors associated with instrumentation, such as the Kristeller maneuver, which can influence avulsion, 30 making it difficult to predict antepartum, 31 although factors that can help predict it have been described. 32 In addition to the novelty of our study (the first to determine any differences in LAM injury between Malmstrom's vacuum and the Kiwi vacuum). It is a prospective, multicenter study, including the position of the fetal head during delivery.…”

Section: Discussionmentioning

confidence: 98%

“…In addition, we have described the position in which the fetal head was found during use of the instrumentation, as in a previous study, to reduce possible confounding factors associated with the instrumentation mode. However, there are other factors associated with instrumentation, such as the Kristeller maneuver, which can influence avulsion, making it difficult to predict antepartum, although factors that can help predict it have been described …”

Section: Discussionmentioning

confidence: 99%

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

González-Díaz

García‐Mejido

Martín‐Martinez

et al. 2019

Neurourology and Urodynamics

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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

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Can pelvic floor trauma be predicted antenatally?

Abstract: Maternal age, body mass index, bladder neck descent and family history of CS are antenatal predictors for levator trauma.

Cited by 25 publications

References 34 publications

Levator ani muscle morphology and function in women with obstetric anal sphincter injury

Levator ani muscle morphology and function in women with obstetric anal sphincter injury

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

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

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