Third‐ or Fourth‐Degree Intrapartum Anal Sphincter Tears Are Associated With Levator Ani Avulsion in Primiparas

Valsky, D. V.; Cohen, S. M.; Lipschuetz, Michal; Hochner‐Celnikier, Drorith; Daum, Hagit; Yagel, Itai

doi:10.7863/ultra.15.04032

Cited by 33 publications

(19 citation statements)

References 44 publications

(69 reference statements)

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“…In previous studies, ORs ranging from 3.5 to 8.1 have been found for OASI as a risk factor for LAM injury 13,18,20,27 . In a study using MRI, the prevalence of LAM injury was 19% among women with OASI and 3.5% in women without sphincter tears 4 .…”

Section: Discussionmentioning

confidence: 94%

“…In a study using MRI, the prevalence of LAM injury was 19% among women with OASI and 3.5% in women without sphincter tears. Using transperineal ultrasound, Valsky et al . found a 40% prevalence of LAM injury in women with OASI, which was significantly higher than that in women without OASI (16%).…”

Section: Discussionmentioning

confidence: 97%

“…If OASI is associated with a high prevalence of LAM injury, the identification of OASI at delivery could be a marker for occult levator trauma 13 . Few studies have explored the prevalence of levator trauma among women with OASI 4,19,20 , and we found no study evaluating a possible effect of LAM injury on pelvic floor muscle contraction, AI and UI among women with OASI.…”

Section: Introductionmentioning

confidence: 91%

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Levator ani muscle morphology and function in women with obstetric anal sphincter injury

Volløyhaug

Taithongchai

Gruting

et al. 2019

Ultrasound in Obstet & Gyne

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Operative vaginal delivery was a risk factor for levator injury in women with OASIs, and levator injury was associated with a weaker pelvic floor muscle contraction. Special attention is recommended for women with OASI and levator injury as they would be at high risk of future pelvic floor disorders. The benefits of implementation of an intensive, focused and structured pelvic floor rehabilitation program needs to be evaluated in these women. This article is protected by copyright. All rights reserved.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 91%

See 1 more Smart Citation

Levator ani muscle morphology and function in women with obstetric anal sphincter injury

Volløyhaug

Taithongchai

Gruting

et al. 2019

Ultrasound in Obstet & Gyne

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“…An advantage with TPUS is that the transducer can be used to assess levator muscle avulsions. Valsky et al demonstrated how 40% of primipara women with OASIS also showed levator ani avulsions with TPUS. Our study population was comprised of both primiparous and multiparous women and showed a slightly lower incidence of levator avulsions analyzed with transperineal ultrasound (n = 17, 29%).…”

Section: Discussionmentioning

confidence: 99%

Comparison of transperineal and endoanal ultrasound in detecting residual obstetric anal sphincter injury

Stuart

Ignell

Örnö

2019

Acta Obstet Gynecol Scand

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Introduction Endoanal ultrasound is considered the gold standard when assessing the obstetric anal sphincter complex. Due to its relative intrusiveness and economic cost, other ultrasound modalities are on the rise, such as transperineal ultrasound with a convex probe. The aim of our study was to evaluate the agreement between endoanal ultrasound scores (EAUS score) and transperineal ultrasound scores (TPUS score) in assessing residual obstetric anal sphincter defects. Material and methods Fifty‐nine women were examined 6 months after primary suturing of obstetric anal sphincter injury with two ultrasound modalities. A standardized scoring system analyzing the length, depth and radial extent of both the external (EAS) and internal (IAS) sphincter was used. Wexner fecal incontinence score was used to assess the patients’ symptoms. Results Transperineal ultrasound scores score showed a strong significant correlation with EAUS score during both pelvic floor relaxation and contraction: Spearman's rho [rs] = 0.74, P < 0.001, and rs = 0.77, P < 0.001, respectively. For both EAS and IAS, significant correlations were found for all parameters, that is, length, depth and angle between both EAUS and TPUS. A statistically significant correlation was found between EAUS score and Wexner score (rs = 0.36, P = 0.005). A significant correlation between the EAS‐EAUS score (rs = 0.36, P = 0.005) and Wexner score was found, but no significance was found between IAS‐EAUS score and Wexner score (rs = 0.22, P = 0.097). Significant correlations were found for Wexner score and TPUS score in resting state (rs = 0.36, P = 0.01) and contracting state (rs = 0.28, P < 0.05), and between Wexner score and EAS‐TPUS score in resting state (rs = 0.32, P = 0.02). Conclusions The results indicated a strong agreement between endoanal and transperineal ultrasound in assessing residual obstetric anal sphincter defects 6 months after primary suturing. Furthermore, a weak significant correlation was found between the ultrasound scores and the patients’ Wexner fecal incontinence score.

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“…The main indications for episiotomy are suspicion of fetal suffering, instrumentalization of childbirth through forceps, or imminent risk of severe perineal tearing. Severe tearing may lead to deeper muscular injuries affecting the levator ani and third and fourth degree tears of the anal sphincter are also associated more with levator ani lesions . Thus, episiotomy is a preventive manoeuvre whose true effect on the musculature of the urogenital hiatus (ie, the levator ani muscle) is poorly understood.…”

Section: Discussionmentioning

confidence: 99%

Impact of episiotomy on the urogenital hiatus using transperineal ultrasound

Garriga¹,

Ruiz²,

Isern³

et al. 2017

Neurourology and Urodynamics

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Third‐ or Fourth‐Degree Intrapartum Anal Sphincter Tears Are Associated With Levator Ani Avulsion in Primiparas

Abstract: Third- and fourth-degree intrapartum sphincter tears are associated with levator ani avulsion. Knowledge of complex pelvic floor damage may allow for prompt referral to secondary preventive measures for pelvic floor disorders.

Cited by 33 publications

References 44 publications

Levator ani muscle morphology and function in women with obstetric anal sphincter injury

Levator ani muscle morphology and function in women with obstetric anal sphincter injury

Comparison of transperineal and endoanal ultrasound in detecting residual obstetric anal sphincter injury

Impact of episiotomy on the urogenital hiatus using transperineal ultrasound

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