Prediction of levator ani muscle avulsion by genital tears after vaginal birth—a prospective observational cohort study

Kimmich, Nina; Birri, Jana; Zimmermann, Roland; Kreft, Martina

doi:10.1007/s00192-020-04297-2

Cited by 9 publications

(7 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The mean age of case group was higher in current study and the mean number of parities and normal vaginal deliveries were significantly more in case group while the mean number of caesarean sections were significantly more in control group. Kimmich's study showed; 14% of women suffered a complete LAM avulsion after vaginal birth and assessing for LAM trauma by translabial ultrasound might be worthwhile [19]. PFDI-20 questionnaire total, pelvic, intestinal, and bladder scores weren't significantly different between two groups.…”

Section: Resultsmentioning

confidence: 96%

Association of Levator Ani Avulsion and Anatomical and Functional Disorders

Mehrbakhsh¹,

Veisi²,

Salimi³

2023

JCOGI

View full text Add to dashboard Cite

Objective: The purpose of this study is to investigate relationship between levator avulsion and anatomical & functional disorders in women who had at least one parity. Methods: Women who complained of pelvic organ prolapse, urinary or defecatory dysfunction were recruited this cohort case-control study. Cases (women with levator defect, diagnosed by 3D translabial ultrasound) and controls (women without levator defect) were compared regarding anterior & posterior vaginal wall prolapse, vaginal apex prolapse, stress & urge urinary incontinence, defecatory dysfunction, increase in urogenital hiatus size, perineal body length, and PFDI-20 questionnaire. Results: The mean age, genital hiatus size, perineal body size, number of parities, normal vaginal deliveries, caesarean sections, measures of vaginal anterior and posterior wall prolapse, prolapse stages, paravaginal prolapse and defecatory disorder prevalence were significantly different between two groups. Body mass index, heaviest baby weight, measure of vaginal apex prolapses, urinary stress and urgency incontinence prevalence, and PFDI-20 questionnaire scores weren’t significantly different between two groups. Conclusion: Levator avulsions seem to increase the risk of vaginal anterior and posterior wall prolapse, voiding dysfunction, paravaginal prolapse and defecatory disorders. The higher age, genital hiatus size, number of parities & normal vaginal deliveries may be associated with the risk of avulsions.

show abstract

Section: Resultsmentioning

confidence: 96%

Association of Levator Ani Avulsion and Anatomical and Functional Disorders

Mehrbakhsh¹,

Veisi²,

Salimi³

2023

JCOGI

View full text Add to dashboard Cite

show abstract

“…Furthermore, we didn’t report the incidence among groups of a non-visible pelvic floor damage in the form of partial or complete avulsions of the levator ani muscle (LAM), that can occur in up to 6-63% of vaginal delivery. LAM can cause short- and long-term PFD symptoms and its incidence is reported to be related to OASIS [ 10 ]. Lastly, due to Covid-19 pandemic, we did not assess PFD symptoms with validated questionnaires but only with a 0-10 VAS.…”

Section: Discussionmentioning

confidence: 99%

When does oasis cause de novo pelvic floor dysfunction? role of the surgeon's skills

et al. 2022

View full text Add to dashboard Cite

Introduction and hypothesis Minorly skilled gynecologists are less likely to repair obstetric anal sphincter injuries (OASIS), and this can lead to higher rate of de novo onset of pelvic floor dysfunction (PFD). The aim of this study was to understand the impact of surgeon skills in OASIS repair on de novo incidence of PFDs. Methods An observational prospective cohort study performed between January 2019 and December 2020. We included 116 women with OASIS. At 6-weeks from delivery, women were divided into two groups in relation to the onset of PFDs. Characteristics were compared; categorical and continuous variables were assessed with chi-squared test and the Mann–Whitney rank-sum test respectively. Factors involved in PFDs development were analysed with explorative univariate analysis; significant (p<0.05) or approaching significance (p≤0.10) variables were included in multivariable analysis. Results Seventy-six women (76/116; 65.5%) reported at least one PFD symptom and anal incontinence was the most prevalent (44.73%; 34/76). OASIS management by a skilled gynaecologist resulted protective for PFDs [aOR 0.33 (0.13-0.61)]. Skilled surgeon reported fewer PFDs than less skilled surgeon (4% vs 82.4%; p<0.0001). Operative delivery was more performed (32.5% vs 15.8%; p= 0.03) and severe OASIS resulted more prevalent (60% vs 17.1%; p<0.0001) among women without PDFs, even if these didn’t affect the incidence of de novo PFDs [aOR 1.03 (0.23-1.45) and 0.83 (0.13-1.45), respectively]. Conclusions Surgeons skilled in OASIS repair resulted the only protective factor for incidence of de novo PFDs in women with OASIS at 6 weeks of follow up. Improvement of training in OASIS repair is necessary.

show abstract

“…It has been suggested that LAM injury is more frequent in women sustaining OASI 31,32 . In agreement with other studies, we observed more OASI in our VBAC cohort [8][9][10]12 .…”

Section: Discussionmentioning

confidence: 99%

Vaginal birth after Cesarean section and levator ani avulsion: a case–control study

Paymova

Švabík

Neumann

et al. 2021

Ultrasound in Obstet & Gyne

View full text Add to dashboard Cite

Objective The aim of this study was to explore the risk of levator ani muscle (LAM) avulsion and enlargement of the levator hiatus following vaginal birth after Cesarean section (VBAC) in comparison with vaginal delivery in primiparous women. Methods In this two‐center observational case–control study, we identified all women who had a term VBAC for their second delivery at the Departments of Obstetrics and Gynecology at the Faculty of Medicine in Pilsen and the 1st Faculty of Medicine in Prague, Charles University, Czech Republic, between 2012 and 2016. Women with a repeat VBAC, preterm birth or stillbirth were excluded from the study. As a control group, we enrolled a cohort of primiparous women who delivered vaginally during the study period. To increase our control sample, we also invited all primiparous women who delivered vaginally in both participating units between May and June 2019 to participate. All participants were invited for a four‐dimensional pelvic floor ultrasound scan to assess LAM trauma. LAM avulsion and the area of the levator hiatus were assessed offline from the stored pelvic floor volumes obtained at rest, during maximum contraction and during Valsalva maneuver. The laterality of the avulsion was also noted. The cohorts were then compared using the χ2 test and Wilcoxon's two‐sample test according to the normality of the distribution. P < 0.05 was considered statistically significant. Multivariate regression analysis, controlling for age and body mass index (BMI), was also performed. Results A total of 356 women had a VBAC for their second delivery during the study period. Of these, 152 (42.7%) attended the ultrasound examination and full data were available for statistical analysis for 141 women. The control group comprised 113 primiparous women. A significant difference was observed between the VBAC group and the control group in age (32.7 vs 30.1 years; P < 0.05), BMI (28.4 vs 27.4 kg/m2; P < 0.05) and duration of the first and second stages of labor (293.1 vs 345.9 min; P < 0.05 and 27.6 vs 35.3 min; P < 0.05, respectively) at the time of the index birth. The LAM avulsion rate was significantly higher in the VBAC compared with the control group (32.6% vs 18.6%; P = 0.01). The difference between the groups was observed predominantly in the rate of unilateral avulsion and remained significant after controlling for age and BMI (adjusted odds ratio 2.061 (95% CI, 1.103–3.852)). There was no statistically significant difference in the area of the levator hiatus at rest (12.0 vs 12.6 cm2; P = 0.28) or on maximum Valsalva maneuver (18.6 vs 18.7 cm2; P = 0.55) between the VBAC and control groups. The incidence of levator hiatal ballooning was comparable between the groups (17.7% and 18.6%; P = 0.86). Conclusions VBAC is associated with a significantly higher rate of LAM avulsion than is vaginal birth in nulliparous women. The difference was significant even after controlling for age and BMI. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

show abstract

Prediction of levator ani muscle avulsion by genital tears after vaginal birth—a prospective observational cohort study

Cited by 9 publications

References 29 publications

Association of Levator Ani Avulsion and Anatomical and Functional Disorders

Association of Levator Ani Avulsion and Anatomical and Functional Disorders

When does oasis cause de novo pelvic floor dysfunction? role of the surgeon's skills

Vaginal birth after Cesarean section and levator ani avulsion: a case–control study

Contact Info

Product

Resources

About