Prevalence of levator hiatal overdistension after vacuum and forceps deliveries

Abstract

Introduction: Levator ani avulsion rates after assisted vaginal delivery have been reported in the literature. However, there are no definitive data regarding the association between overdistention and assisted vaginal delivery. Therefore, our aim is to report overdistention rates after assisted vaginal delivery with a postpartum ultrasound examination. Materials and Methods:This multicenter study involved a retrospective analysis of data from primiparous women (n = 602) who had previously been recruited at three tertiary hospitals between January 2015 and January 2017. Overdistention was assessed at 6 months postpartum using three-/four-dimensional transperineal ultrasound. Patients with levator ani muscle avulsion were excluded. Overdistention was defined as a levator hiatal area ≥ 25 cm 2 on Valsalva.Results: Of the 602 primiparous patients, 250 patients who satisfied the inclusion criteria (139 patients who underwent forceps delivery and 111 patients who underwent vacuum delivery) were evaluated. Overdistention occurred in 20% (50 of 250) of these patients. Overdistention was observed for 1% (1/111) of vacuum deliveries and 35.3% (49 of 139) of forceps deliveries. We found an increased risk of overdistention following forceps delivery compared to vacuum delivery, with a crude odds ratio (OR) of 59.9 (95% confidence interval [CI]: 8.1, 442.2) and an adjusted OR (adjusted for maternal age, second-stage duration, and head circumference) of 17.6 (95% CI: 2.3, 136.7).Conclusions: Postpartum overdistention occurred for 20% of assisted vaginal deliveries, with an increased risk of overdistention following forceps delivery compared to vacuum delivery. K E Y W O R D S3D transperineal ultrasound, forceps delivery, levator ani muscle, overdistention, vacuum delivery

The dynamic change of the anteroposterior diameter of the levator hiatus under Valsalva maneuver at term and labor outcome

“…Clinical assessment of the pelvic floor muscles is subjective and poorly reproducible 3 . Over the past few years, many studies have demonstrated that transperineal ultrasound (TPU) is a reliable and reproducible instrument for the assessment of pelvic floor muscle integrity and function, both in static and dynamic conditions 4‐9 . Proper pelvic floor contraction normally leads to a reduction in levator hiatal dimensions 10 whereas increased levator hiatus dimensions under Valsalva maneuver indicates pelvic floor distensibility and proper LAM relaxation 11 .…”

“…3 Over the past few years, many studies have demonstrated that transperineal ultrasound (TPU) is a reliable and reproducible instrument for the assessment of pelvic floor muscle integrity and function, both in static and dynamic conditions. [4][5][6][7][8][9] Proper pelvic floor contraction normally leads to a reduction in levator hiatal dimensions 10 whereas increased levator hiatus dimensions under Valsalva maneuver indicates pelvic floor distensibility and proper LAM relaxation. 11 Some women are unable to relax their pelvic floor under Valsalva, thus leading to a reduction in the anteroposterior diameter (APD) of the levator hiatus during Valsalva maneuver.…”