Prevalence of levator ani muscle injury and health-related quality of life in primiparous Chinese women after instrumental delivery

Chung, Man-Kin; Wan, Osanna Y K; Cheung, Ray C. C.; Chung, Tony K.H.; Chan, Symphorosa Shing Chee

doi:10.1002/uog.14700

Cited by 38 publications

(50 citation statements)

References 33 publications

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“…Forceps delivery was associated with a more than three‐fold increase in major levator trauma . These findings have since been confirmed by a number of other studies …”

Section: Discussionsupporting

confidence: 66%

“…The risk of avulsion, i.e. traumatic detachment of the levator ani muscle from the pubic bone, has been shown to be markedly more prevalent after forceps compared with normal vaginal deliveries and vacuum extraction . This form of obstetric trauma has important long‐term implications such as sexual and pelvic floor dysfunction .…”

Section: Introductionmentioning

confidence: 99%

“…traumatic detachment of the levator ani muscle from the pubic bone, has been shown to be markedly more prevalent after forceps compared with normal vaginal deliveries and vacuum extraction. 10,[19][20][21][22][23] This form of obstetric trauma has important long-term implications such as sexual and pelvic floor dysfunction. 24 The strong association between levator muscle avulsion and female POP is increasingly recognised.…”

Section: Introductionmentioning

confidence: 99%

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Delivery mode and pelvic organ prolapse: a retrospective observational study

Trutnovsky

Atan

Martin

et al. 2015

BJOG

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Objective To analyse the associations between delivery mode and symptoms and signs of pelvic organ prolapse (POP) in a cohort of symptomatic women.Design Retrospective observational study.Population A total of 1258 consecutive women attending a tertiary urogynaecological unit for the investigation of lower urinary tract or pelvic floor disorders between January 2012 and December 2014.Methods Obstetric history and clinical examination data were obtained from the unit database. Prolapse quantification on imaging was performed using stored four-dimensional translabial ultrasound volume data sets. Women were grouped into four groups according to the most traumatic delivery reported. The presence of symptoms and signs of POP were compared between delivery groups while controlling for potential confounders.Main outcome measures Prolapse symptoms, visual analogue score for prolapse bother, International Continence Society Prolapse Quantification System findings and ultrasound findings of anterior, central and posterior compartment descent.Results Nulliparae showed the lowest prevalence of most measures of POP, followed by women exclusively delivered by caesarean section. Highest prevalences were consistently found in women delivered at least once by forceps, although the differences between this group and women delivered by normal vaginal delivery and/or vacuum extraction were significant in three out of eight measures only. Compared with women in the caesarean section group, the adjusted odds ratios for reporting symptoms of prolapse were 2.4 (95% CI 1.30-4.59) and 3.2 (95% CI 1.65-6.12) in the normal vaginal delivery/vacuum extraction group and forceps group, respectively.Conclusions There is a clear link between vaginal delivery and symptoms and signs of pelvic organ prolapse in urogynaecological patients.Keywords Caesarean section, delivery, forceps, pelvic organ prolapse.Tweetable abstract Compared with caesarean section a history of vaginal delivery more than doubles the risk for POP.

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“…Forceps delivery was associated with a more than three‐fold increase in major levator trauma . These findings have since been confirmed by a number of other studies …”

Section: Discussionsupporting

confidence: 66%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Delivery mode and pelvic organ prolapse: a retrospective observational study

Trutnovsky

Atan

Martin

et al. 2015

BJOG

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“…23 In fact, the application of rotational forceps in some centers is very infrequent, with intrapartum cesarean section being the chosen option for difficult instrumental deliveries. The use of forceps has been described as a major risk factor for levator ani muscle injury, 24,28,44,48 with no studies describing the characteristics of application. The use of forceps has been described as a major risk factor for levator ani muscle injury, 24,28,44,48 with no studies describing the characteristics of application.…”

Section: Malmström Vacuum and Kielland Forceps Deliveriesmentioning

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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“…There is ample evidence that childbirth or LAM injury is an important contributing factor for pelvic floor disorders [21,22,17,4]. Birth related LAM defect can be identified early postpartum with different imaging modalities; however, the impact of LAM injury on the pelvic floor is likely to emerge later in life.…”

Section: Discussionmentioning

confidence: 99%

Characteristics associated with pelvic organ prolapse in women with significant levator ani muscle deficiency

et al. 2015

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Introduction and Hypothesis Age is a risk factor associated with symptomatic pelvic organ prolapse (POP) among women with significant levator ani deficiency. Methods This cross-sectional study included patients who were referred for varied pelvic floor disorders, had 3D endovaginal ultrasound as part of their evaluation, and were diagnosed with significant levator ani muscle deficiency defined as a score of 12 or more on 3D endovaginal ultrasound. Patients were categorized as control group (stage 0 and 1), or symptomatic prolapse (stage 2–4). Results Seventy-six women were available for analysis and found to have significant levator ani muscle deficiency, including 51 with symptomatic POP and 25 without POP. Patients with symptomatic POP were older, mean age 66 (SD± 11.8) vs 48 (SD± 17.3) years; p<0.0001, had greater mean minimal levator hiatus area 19.7 cm2 (SD± 4.6) vs 17.5 cm2 (SD±3.5); p=0.048, and were more likely to be menopausal (91.3% vs 54.5%; p<0.001) compared to those with no POP. In a modified Poisson regression analysis excluding nulliparous women, increasing age (RR=2.39, 95% CI 1.03–5.55) and smoking (RR=1.34, 95% CI 1.08–1.67) remained associated with symptomatic POP after controlling for one another and the MLH area. Conclusions Among women with significant levator ani deficiency, older women and smokers had an increased prevalence of symptomatic POP. On average, women without POP but with significant levator ani deficiency were 18 years younger than women with POP and significant muscle deficiency.

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Prevalence of levator ani muscle injury and health-related quality of life in primiparous Chinese women after instrumental delivery

Abstract: Objectives Levator ani muscle (LAM) injury is common after first vaginal delivery, and a higher incidence is

Cited by 38 publications

References 33 publications

Delivery mode and pelvic organ prolapse: a retrospective observational study

Delivery mode and pelvic organ prolapse: a retrospective observational study

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

Characteristics associated with pelvic organ prolapse in women with significant levator ani muscle deficiency

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