Pelvic floor morphometry and function in women with and without puborectalis avulsion in the early postpartum period

Cyr, Marie-Pierre; Kruger, Jennifer; Wong, Vivien; Dumoulin, Chantale; Girard, Isabelle; Morin, Mélanie

doi:10.1016/j.ajog.2016.11.1049

Cited by 37 publications

(32 citation statements)

References 60 publications

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“…However, to what extent levator hiatal dimensions and LAM relaxation may affect the outcome of labor remains a matter of debate, with conflicting results reported in the literature [19][20][21][22]27 . With the introduction of TPU, objective quantitative assessment of pelvic organ mobility, levator hiatal dimensions and their dynamic changes became feasible [28][29][30][31][32][33][34][35] . While some studies have shown an increased risk of operative delivery in women with reduced antenatal pelvic organ mobility on Valsalva maneuver and in women with smaller levator hiatal dimensions 19,20,22 , others have not confirmed these findings 21 .…”

Section: Discussionmentioning

confidence: 99%

Levator ani muscle coactivation at term is associated with longer second stage of labor in nulliparous women

Youssef

Montaguti

Dodaro

et al. 2019

Ultrasound in Obstet & Gyne

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Objective To assess the effect of levator ani muscle (LAM) coactivation at term on outcome of labor in nulliparous women. Methods This was a prospective study of 284 low‐risk nulliparous women with a singleton pregnancy at term recruited before the onset of labor. The anteroposterior diameter of the levator hiatus was measured in each woman on transperineal ultrasound at rest, on maximum pelvic floor muscle contraction and on maximum Valsalva maneuver before and after visual feedback. LAM coactivation was defined as a reduction in the anteroposterior diameter of the levator hiatus on maximum Valsalva maneuver in comparison with that at rest. The association of pelvic hiatal diameter values and LAM coactivation with mode of delivery and duration of labor was assessed. Results No significant difference was found between women who underwent Cesarean delivery and those who had a vaginal delivery with regard to the anteroposterior diameter of the levator hiatus at rest, on pelvic floor muscle contraction and on Valsalva maneuver. Longer second stage of labor was associated with shorter anteroposterior diameter of the levator hiatus on all assessments, but in particular at rest and on Valsalva both before and after visual feedback. LAM coactivation was found in 89 (31.3%) and 75 (26.4%) women before and after visual feedback, respectively. Post visual feedback, women with LAM coactivation had a significantly longer second stage of labor than did those without LAM coactivation (83 ± 63 vs 63 ± 42 min; P = 0.006). On Cox regression analysis, LAM coactivation post visual feedback was an independent predictor of longer second stage of labor (adjusted hazard ratio, 1.499 (95% CI, 1.076–2.087); P = 0.017). Conclusion LAM coactivation in nulliparous women at term is associated with a longer second stage of labor. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

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Section: Discussionmentioning

confidence: 99%

Levator ani muscle coactivation at term is associated with longer second stage of labor in nulliparous women

Youssef

Montaguti

Dodaro

et al. 2019

Ultrasound in Obstet & Gyne

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“…11 The main risk factor for the appearance of these levator ani muscle injuries is vaginal delivery, 12 which is associated with an increase in the levator muscle hiatus, 13,14 especially in cases of levator ani muscle avulsion. 16 These alterations, associated with a decrease in strength and with age-related fibrosis, represent the probable mechanisms for pelvic floor muscle dysfunction in elderly women. 16 These alterations, associated with a decrease in strength and with age-related fibrosis, represent the probable mechanisms for pelvic floor muscle dysfunction in elderly women.…”

Section: Introductionmentioning

confidence: 99%

A comparable rate of levator ani muscle injury in operative vaginal delivery (forceps and vacuum) according to the characteristics of the instrumentation

García‐Mejido

Fernández‐Palacín

Barby

et al. 2019

Acta Obstet Gynecol Scand

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Abbreviations: CI, confidence interval; LAM, levator ani muscle; OR, odds ratio. AbstractIntroduction: Forceps delivery is associated with a high rate of levator ani muscle (LAM) trauma (avulsion) at 35%-65% whereas data on avulsion rates after vacuum delivery vary greatly. Nevertheless, a common characteristic of all previous studies carried out to evaluate the association between instrumental deliveries (forceps and vacuum) and LAM avulsion, is the fact that characteristics of the instrumentation have not been described or evaluated. The objective of this study is to compare the rate of LAM avulsion between forceps and vacuum deliveries according to the characteristics of the instrumentation. Material and methods: Prospective, observational study, including 263 nulliparous women, who underwent an instrumental delivery with either Malmström vacuum or Kielland forceps. The characteristics of the instrumentation, position (anterior position and other position) and height of the fetal head at the moment of instrumentation (low instrumentation [vertex at +2 station] and mid-instrumentation [head isinvolved but leading part above +2 station]) were assessed. Evaluation of LAM avulsion was performed at 6 months postpartum by three-/four-dimensional transperineal ultrasound. Using the multi-view mode, a complete avulsion was diagnosed when the abnormal muscle insertion was identified in all three central slices, that is, in the plane of minimal hiatal dimensions and the 2.5-mm and 5.0-mm slices cranial to this one. To detect a 30% or 15% difference in the LAM injury rate, with 80% power and 5% α-error, we needed, respectively 42 and 99 women per study group.Results: In all, 263 nulliparous individuals have been evaluated (162 vacuum deliveries, 101 forceps deliveries). Instrumentation in an occipito-anterior position was more frequent in vacuum deliveries (75.3% vs 56.4%, P = .002), whereas other positions were more frequent in the forceps deliveries group (24.7% vs 43.6%). No statistically significant differences were noted regarding the height of the fetal head at the moment of instrumentation. No statistically significant differences were found in the presence of LAM avulsion (41.4% vs 38.6%) between vacuum and forceps deliveries.The univariate analysis of the crude odds ratio was 1.17, 95% CI 0.67-1.98, P = .70 for

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“…Dysfunction of the mechanical properties of the female pelvic floor muscles (PFMs) is thought to contribute to a wide array of urogynecological disorders known to impair quality of life such as urinary incontinence, pelvic organ prolapse, and dyspareunia . Intravaginal dynamometry is recognized as an optimal tool to quantify active and passive pelvic floor tissue properties .…”

Section: Introductionmentioning

confidence: 99%

“…such as urinary incontinence, pelvic organ prolapse, and dyspareunia. [1][2][3] Intravaginal dynamometry is recognized as an optimal tool to quantify active and passive pelvic floor tissue properties. [4][5][6][7] Relative measures of PFM force generating capacity acquired by intravaginal dynamometry have demonstrated excellent reliability 4,6,8,9 and correlate strongly with manual measures of PFM strength, 4,10 the current standard for clinical assessment of the female PFMs.…”

mentioning

confidence: 99%

The impact of a familiarization session on the magnitude and stability of active and passive pelvic floor muscle forces measured through intravaginal dynamometry

Czyrnyj

Bérubé

Varette

et al. 2019

Neurourology and Urodynamics

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Aims The aim of this study was to investigate the impact of task familiarization on (1) the magnitude and (2) the repeatability of active and passive properties of the female pelvic floor muscles (PFMs) measured using automated intra‐vaginal dynamometry. Methods Women attended three laboratory sessions at one‐week intervals. After receiving initial task instruction and feedback at the start of the first session, standardized instructions were given while women performed maximal effort voluntary contractions of their PFMs with the dynamometer arms open at two different diameters and kept their PFMs relaxed while the dynamometer arms opened to 40 mm at two speeds. Outcomes included baseline force, peak force, relative peak forces (N), rate of force development (N/s) and stiffness. Between session effects were tested for all outcomes using one‐way ANOVAs. Intra‐class correlation coefficients (ICCs) and minimal detectable change values were computed within each session and between sessions 1 and 2 and sessions 2 and 3. Results Twenty nulliparous women (mean age = 35 ± 15 years) participated. No differences in the mean values were found across the three visits for any outcomes. Within sessions, neither ICC nor minimal detectable change differed among sessions and between‐session ICC values were not different between visits 1 and 2 and visits 2 and 3. Conclusions There is no evidence of a familiarization effect over a two‐week period on the amplitude nor repeatability of dynamometric measures of active or passive PFM properties recorded from nulliparous women.

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Pelvic floor morphometry and function in women with and without puborectalis avulsion in the early postpartum period

Cited by 37 publications

References 60 publications

Levator ani muscle coactivation at term is associated with longer second stage of labor in nulliparous women

Levator ani muscle coactivation at term is associated with longer second stage of labor in nulliparous women

A comparable rate of levator ani muscle injury in operative vaginal delivery (forceps and vacuum) according to the characteristics of the instrumentation

The impact of a familiarization session on the magnitude and stability of active and passive pelvic floor muscle forces measured through intravaginal dynamometry

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