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

Abstract

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.

Ultrasound assessment of pelvic floor muscle contraction: reliability and development of an ultrasound‐based contraction scale

“…For proportional change in 2D levator hiatal AP diameter, the ICC of 0.81 for intrarater reliability indicates excellent reliability. The ICC (average of the three raters) of 0.82 implies excellent agreement between the raters in this population 25 , and is higher than the ICC (average of two raters) of 0.77 found in another recent publication 29 . The ICC (single measurement) of 0.61, providing information on the performance of the test in a clinical setting in which one examiner assesses one woman, is good, and the method is acceptable to use in such settings.…”

“…This high prevalence is in agreement with that in previous publications in women with pelvic organ prolapse scheduled for surgery 27,28 . Previous publications have found that women with major levator trauma had reduced pelvic floor contraction compared with those without trauma 6,29 . Additionally, in the present study, we found a 3-fold increased prevalence of major levator trauma among women with absent to weak contraction compared with those with moderate to strong contraction.…”

“…Most previous intra-and interrater reliability studies on ultrasound assessment of pelvic floor muscle contraction have compared measurements taken either at rest or on contraction 22,[30][31][32][33] , and only a few have compared the change between rest and contraction 29 . In the present study, the ICC was also found to be higher for absolute measurements than the proportional change between rest and contraction.…”

“…The strength of correlation (r S ) between ultrasound measurements and MOS score was 0.52 for 2D AP diameter, 0.62 for 3D AP diameter and 0.47 for hiatal area (P < 0.001 for all). On the ultrasound contraction scale, proportional change in 2D levator 126 Nyhus et al hiatal AP diameter of < 1% corresponds to absent,[2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] Conclusions Ultrasound seems to be an objective and reliable method for evaluation of pelvic floor muscle contraction. Proportional change in 2D levator hiatal AP diameter had the highest ICC and moderate correlation with MOS score assessed by vaginal palpation, and we constructed an ultrasound scale for assessment of pelvic floor muscle contraction based on this measure.…”

Comparison of transperineal and endoanal ultrasound in detecting residual obstetric anal sphincter injury

“…Our study population was comprised of both primiparous and multiparous women and showed a slightly lower incidence of levator avulsions analyzed with transperineal ultrasound (n = 17, 29%). A recent study also showed a 29% prevalence of levator avulsions in conjunction with OASIS, with instrumental delivery increasing the risk of levator injury fourfold 16. The downside of transperineal ultrasound, however, could beinsufficient sensitivity in detecting OASIS.…”