Change in prevalence of major levator ani muscle defects from 6 weeks to 1 year postpartum, and maternal and obstetric risk factors: A longitudinal ultrasound study

Abstract

Introduction The present study aimed first to investigate the change in prevalence of major levator ani muscle (LAM) defects, also called avulsions, from 6 weeks to 1 year postpartum, and second to assess maternal and obstetric risk factors for having persistent major LAM defects/avulsions at 1 year postpartum. Material and methods This is a secondary analysis of data from a prospective cohort study including 300 nulliparous women at 17‐19 weeks of gestation. Major LAM defects were diagnosed at 6 weeks and 1 year postpartum using transperineal ultrasonography. We defined persistent major LAM defects as a defect diagnosed both at 6 weeks and 1 year postpartum. Maternal and obstetric data were obtained from the hospital’s electronic birth records. Pelvic floor muscle function was measured vaginally by manometer at 21 weeks of gestation. The main outcome measurement was change in prevalence of major LAM defects. Maternal and obstetric risk factors for having persistent major LAM defect were also assessed. Results Prevalence of major LAM defects was 19.4% at 6 weeks and 10.4% at 1 year postpartum. No new major LAM defects were diagnosed at 1 year postpartum. Persisting major LAM defects were associated with longer second stage of labor (median 74.5 minutes vs median 48.0 minutes, P = .012) and higher neonatal birthweight (mean difference of 232.3 g, 95% confidence interval [CI] 21.5‐443.1). Vacuum delivery was independently associated with persistent major LAM defects, adjusted OR 3.0 (95% CI 1.0‐9.0). Conclusions There was a 50% reduction of sonographically diagnosed major LAM defects from 6 weeks to 1 year postpartum. This finding suggests that assessment of the major LAM 6 weeks postpartum may be too early to diagnose defects/avulsions. Long second stage of labor, high neonatal birthweight and vacuum delivery were associated with persistent major LAM defects/avulsions.

Evaluation of Levator ani muscle injury in primiparous women at one and six week’s postpartum using 3D transperineal ultrasound: comparative Cohort study

“…It could be explained that we included both minor avulsions and hematomas, which are possibly disappeared in comparison to major injuries. A similar decrease in the incidence of LAM avulsion was also observed in several studies [18][19][20]. In this study, there was a non-significant correlation between levator ani avulsions and stress urinary incontinence which matches what have been observed by Delaney et al who found that visible defects in the levator ani muscle occurred with similar frequency in cases of SUI and controls [21].…”

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

“…Albrich et al [12] was excluded because presented a single case of LAM avulsion in one patient with FD. The estimated joint OR for VD vs. NVD was 2.02 (95% CI: 1.34-3.03), including the exploration of Halle et al [35] at 6 weeks postpartum (Fig. 2, Ref.…”

“…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.…”

Physiotherapeutic treatment for levator ani avulsion after delivery: A transperineal three-dimensional ultrasound assessment

“…Despite a study showing to 50% reduction in injuries observed by transperineal 3DUS comparing assessments of 6 weeks postpartum to 1 year after delivery in the same patient,[ 17 ] other authors have observed 15.2% rate of avulsion after 20 years of delivery. [ 18 ] We believe that the earlier the woman undergoes perineal rehabilitation after delivery, better she will recover.…”