Levator avulsion and grading of pelvic floor muscle strength

Dietz, Hans Peter; Shek, C.

doi:10.1007/s00192-007-0491-9

Cited by 154 publications

(126 citation statements)

References 13 publications

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“…Previous studies in prolapse patients have revealed a reduced PFMS in women with LAM avulsion. 11,12 Moreover, supervised pelvic floor muscle training to increase PFMS in women with POP can improve severity of prolapse and reduce prolapse symptoms. 44 Postnatal hiatus area was significantly larger in women with major LAM avulsion (except at rest), compared with women without LAM avulsion.…”

Section: Discussionmentioning

confidence: 99%

“…7 A 2.4-2.9 fold increase of anatomical cystocele recurrence has been shown in women with LAM avulsion, although not all women were symptomatic. 8,9 In addition to POP, 5,6,10 women with LAM avulsion are at risk of a reduction in pelvic floor muscle strength (PFMS) [11][12][13] and an increased vaginal hiatus. [14][15][16] Although the literature is ambiguous, these anatomical changes may lead to symptoms of pelvic floor dysfunction (PFD).…”

Section: Introductionmentioning

confidence: 99%

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The relationship between postpartum levator ani muscle avulsion and signs and symptoms of pelvic floor dysfunction

Delft

Sultan

Thakar

et al. 2014

BJOG

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Objective To establish the relationship between postpartum levator ani muscle (LAM) avulsion and signs and/or symptoms of pelvic floor dysfunction (PFD).Design Observational longitudinal cohort study.Setting District General University Hospital, UK.Population or sample Primigravida at 36 weeks' gestation and 3 months postpartum.Methods Pelvic floor muscle strength (PFMS) and pelvic organ prolapse were assessed clinically using validated methods. Transperineal ultrasound was performed to identify LAM avulsion and measure hiatus dimensions. Validated questionnaires evaluated sexual function, urinary and faecal incontinence.Main outcome measures PFD signs and symptoms related to LAM avulsion.Results Two hundred and sixty nine primigravida without LAM avulsion participated and 71% (n = 191) returned postpartum. LAM avulsion was found in 21% of vaginal deliveries (n = 30, 95%CI 15.1-28.4%). Women with minor and major avulsion had worse PFMS (P < 0.038) and more anterior compartment prolapse (maximum stage 2; P < 0.024). Antenatal hiatus antero-posterior diameter on ultrasound was significantly smaller in women sustaining avulsion (P = 0.011). Postnatal measurements were significantly increased following avulsion. Women with major avulsion were less sexually active at both antenatal and postnatal periods (P < 0.030). These women had more postnatal urinary incontinence and symptoms such as reduced vaginal sensation and 'too loose vagina'. No postnatal differences were found for faecal incontinence, prolapse symptoms or quality of life. The correlation of differences in variables was only slight-fair with avulsion severity.Conclusions Twenty one percent of women sustain LAM avulsion during their first vaginal delivery with significant impact on signs and symptoms of PFD. As avulsion has been described as the missing link in the development of prolapse; longer term follow-up is vital.Keywords Childbirth, incontinence, levator ani avulsion, pelvic floor dysfunction, pelvic organ prolapse, transperineal ultrasound.Please cite this paper as: van Delft K, Sultan AH, Thakar R, Schwertner-Tiepelmann N, Kluivers K. The relationship between postpartum levator ani muscle avulsion and signs and symptoms of pelvic floor dysfunction.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The relationship between postpartum levator ani muscle avulsion and signs and symptoms of pelvic floor dysfunction

Delft

Sultan

Thakar

et al. 2014

BJOG

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“…It is clearly related to vaginal childbirth [3,4], with Forceps delivery, length of second stage and foetal size as likely risk factors [5,6]. Such trauma is associated with abnormal muscle biometry and function as well as female pelvic organ prolapse [1,2,[7][8][9]. Avulsion increases the area of the levator hiatus [5,7], the largest potential hernial portal in the abdominal envelope.…”

Section: Introductionmentioning

confidence: 99%

Minimal criteria for the diagnosis of avulsion of the puborectalis muscle by tomographic ultrasound

et al. 2010

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Introduction and hypothesis Puborectalis avulsion is a likely etiological factor for female pelvic organ prolapse (FPOP). We performed a study to establish minimal sonographic criteria for the diagnosis of avulsion. Methods We analysed datasets of 764 women seen at a urogynecological service. Offline analysis of ultrasound datasets was performed blinded to patient data. Tomographic ultrasound imaging (TUI) was used to diagnose avulsion of the puborectalis muscle.

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“…MRI can show the axial plane, but it is expensive, not readily available and time consuming. Moreover, due to the physical properties of the device, required maneuvers cannot always be performed by the patient during dynamic MRI [44].…”

Section: Urogynecologymentioning

confidence: 99%

Role of Three-Dimensional Ultrasound in Gynecology

Türkgeldi

Urman

Ata

2014

J Obstet Gynecol India

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Three-dimensional ultrasound (3D USG) is a fast-evolving imaging technique that holds a great potential for use in gynecology. Its sensitivity and specificity is reported to be close to 100 % for diagnosing congenital uterine anomalies, comparable with those of magnetic resonance imaging (MRI) and laparoscopy. With 3D USG, a coronal view of the uterus can be obtained, clearly outlining the external contour of the uterus and providing accurate information about the shape of the cavity. Although 3D USG may not perform well in thin endometria, combining it with saline infusion sonography (SIS) overcomes this problem. Research shows that 3D USG is more sensitive and specific than two-dimensional ultrasound (2D USG) in defining and mapping uterine lesions, such as fibroids, adenomyosis, and intrauterine synechia. In cases of suspected malignancy, 3D USG is mainly used in the initial evaluation of patients. Measuring various indices and mapping vascular architecture with 3D power Doppler have been proposed for evaluating adnexal masses. Although some studies raised hope, no consensus is reached about its use, success, and limitations. In urogynecology, translabial 3D USG is proved to be a valuable tool, as it provides instant access to the axial plane, which clearly depicts the relationship of the vagina, urethra, rectum, and the muscular pelvic floor. Studies report no significant differences between translabial 3D USG and MRI measurements for evaluation of the pelvic floor. In conclusion, adding 3D USG to routine gynecological workup can be beneficial for clinicians, as it provides fast and accurate results in a relatively cost-effective setting.

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Levator avulsion and grading of pelvic floor muscle strength

Cited by 154 publications

References 13 publications

The relationship between postpartum levator ani muscle avulsion and signs and symptoms of pelvic floor dysfunction

The relationship between postpartum levator ani muscle avulsion and signs and symptoms of pelvic floor dysfunction

Minimal criteria for the diagnosis of avulsion of the puborectalis muscle by tomographic ultrasound

Role of Three-Dimensional Ultrasound in Gynecology

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