Four‐dimensional sonographic evaluation of avulsion of the levator ani according to delivery mode

Garriga, Jordi Cassadó; Isern, Antoni Pessarrodona; Pons, Montserrat Espuña; Retamal, Montserrat Durán; Fabrega, A. Felgueroso; Rodríguez-Carballeira, Mónica; Santamaria, I. Jordà

doi:10.1002/uog.10062

Cited by 27 publications

(29 citation statements)

References 26 publications

(32 reference statements)

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“…The result is consistent with previously published data28-29, which reported an injury rate ranging from 13.3% to 38.5% after spontaneous vaginal delivery.…”

Section: Discussionsupporting

confidence: 93%

Three-dimensional Ultrasound Appearance of Pelvic Floor in Nulliparous Women and Postpartum Women One Week after Their First Delivery

Liu¹,

Xu²,

Ying³

et al. 2014

Int. J. Med. Sci.

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This study investigated the morphology and structure of pelvic floor in 50 nulliparous and 95 postpartum women (47 vaginal delivery, 48 Cesarean section) using translabial three-dimensional (3D) ultrasound. All the primiparae underwent ultrasound examination within one week after their first delivery. Volume datasets were acquired and analyzed to determine the alterations of levator hiatus after childbirth. Significant differences were observed in the levator hiatus of postpartum women compared with that of nullipara women. In postpartum women, the levator hiatus, with their dimensions increased, expanded into a circular shape. Puborectalis was avulsed in eight cases (accounting for 8.42% of all) and pelvic organ prolapse was found in 12 cases (accounting for 12.63%). The hiatal dimensions were larger and the incidence of pubrectalis muscle avulsion (17.02% vs. 0%) and pelvic organ prolapse (21.28% vs. 4.17%) was significantly higher in Vaginal delivery group than Cesarean section group. In summary, 3D ultrasound is an effective tool to detect the pelvic floor of postpartum women who present with morphological abnormalities, and such abnormalities are more likely to show in vaginal delivery women compared to Cesarean section.

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“…The result is consistent with previously published data28-29, which reported an injury rate ranging from 13.3% to 38.5% after spontaneous vaginal delivery.…”

Section: Discussionsupporting

confidence: 93%

Three-dimensional Ultrasound Appearance of Pelvic Floor in Nulliparous Women and Postpartum Women One Week after Their First Delivery

Liu¹,

Xu²,

Ying³

et al. 2014

Int. J. Med. Sci.

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“…The significance of age in our findings concurs with the results of some researchers [4]-[9]; however, other investigators did not find a significant difference associated with age in other studies focused on women who were primigravidas [7] [8] [11]. As shown in Table 1 , this may be due to sampling differences.…”

Section: Discussionsupporting

confidence: 92%

“…Chan [8] study- ing women in Hong Kong, reported mean age of 30.6 ± 3.9 years, which was similar to our sample, however they did not identify an association with LA injury in the bivariate analysis. In the Cassadó Garriga [11] study located in Spain, age was similar to our study, but the sampling reflected a case/control study, with cases selected on the basis of forceps delivery [11]. Their findings concur with others that forceps is an overwhelming factor in LA tear.…”

Section: Discussionsupporting

confidence: 84%

“…More recently, investigators have used larger sample sizes and statistical analysis techniques that are more sophisticated to explore the question of predicting LA injury [8] [11]. However, even findings from these studies have not provided a consistent profile.…”

Section: Discussionmentioning

confidence: 99%

“…These studies explored broadly for maternal characteristics and childbirth events that might identify women with even a slight LA tear. Factors shown to be significant in at least one study include: higher maternal age, forceps or vacuum delivery, anal sphincter laceration, prolonged second stage, episiotomy, greater infant size [4], and infant head circumference, [7]-[11] ( Table 1 ). However, conflicting results remained since the factors are numerous and interrelated.…”

Section: Introductionmentioning

confidence: 99%

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Predicting Birth-Related Levator Ani Tear Severity in Primiparous Women: Evaluating Maternal Recovery from Labor and Delivery (EMRLD Study)

Low¹,

Zielinski²,

Tao³

et al. 2014

OJOG

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Objective To determine which maternal characteristics or birth events independently predict severity of levator ani muscle (LA) tears at first vaginal birth in a longitudinal/observational investigation in a tertiary care hospital. Sample Ninety primiparas with at least one at risk for LA tear inclusion factor at vaginal birth: maternal age ≥ 33 years, second stage ≥ 150 minutes, macrosomia, instrumented delivery, and/or anal sphincter laceration were studied. Methods Magnetic Resonance Imaging (MRI) was obtained early postpartum (mean ± sd 48.9 ± 21.6 days) to identify LA tear. Severity of LA muscle fiber loss was graded on an ordinal scale of: “0” as no loss, “1” as <50% unilateral loss, “2” as ≥50% unilateral or <50% bilateral loss, and “3” as ≥50% bilateral loss. Data were analyzed using proportional odds modeling. Inclusion factors were explored as predictors of LA tear severity and at analysis episiotomy, time spent actively pushing, epidural, and oxytocin were also considered. The main outcome measures of interest included grading of severity of LA muscle fiber loss on an ordinal scale. Results Respective counts/percentages of women within each 0 thru 3 ordered category of LA tear severity were: “0” = 58(64%), “1” = 9(10%), “2” = 15(17%), and “3” = 8(9%). Estimates and 95% CI for significant demographic or obstetric univariate predictors of LA tear severity level were age, OR 1.093 (CI 1.012 - 1.180), p = 0.023; and time spent in active pushing, OR 1.089 (CI 1.005 - 1.180), p = 0.038. The other factors considered were not significant. There were too few women with forceps deliveries to analyze. Conclusion: In our enriched sample of primiparous women, 26% showed a significant LA tear. Maternal age and time spent actively pushing independently predict LA tear severity.

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Accuracy of MRI, ultrasound and vaginal assessment for the diagnosis of levator ani muscle avulsion in women

Gruting

Delft

Thakar

et al. 2015

Cochrane Database of Systematic Reviews

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Four‐dimensional sonographic evaluation of avulsion of the levator ani according to delivery mode

Abstract: Objective To determine the frequency of avulsion of the levator ani muscle in primiparous women according to delivery mode, using introital four-dimensional ultrasonography. Methods

Cited by 27 publications

References 26 publications

Three-dimensional Ultrasound Appearance of Pelvic Floor in Nulliparous Women and Postpartum Women One Week after Their First Delivery

Three-dimensional Ultrasound Appearance of Pelvic Floor in Nulliparous Women and Postpartum Women One Week after Their First Delivery

Predicting Birth-Related Levator Ani Tear Severity in Primiparous Women: Evaluating Maternal Recovery from Labor and Delivery (EMRLD Study)

Accuracy of MRI, ultrasound and vaginal assessment for the diagnosis of levator ani muscle avulsion in women

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