Delivery mode and the risk of levator muscle avulsion: a meta-analysis

Friedman, Talia; Eslick, Guy D.; Dietz, Hans Peter

doi:10.1007/s00192-018-3827-8

Cited by 64 publications

(42 citation statements)

References 42 publications

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“…Therefore, in our work, we first described the characteristics of the application of each instrument to reduce possible confounding factors that may influence the appearance of levator ani muscle injuries. In a recent meta-analysis, 26 an OR of 4.45 (95% CI 3.09-6.42) was established when comparing the avulsions produced by forceps vs vacuum. In our work, we obtained a higher rate of injuries in deliveries instrumented with vacuum.…”

Section: Ta B L E 3 Levator Ani Muscle Injury and General Levator Hiamentioning

confidence: 99%

“…22 Considering the risk factors associated with levator ani muscle avulsion in vaginal deliveries, the use of forceps 23 has proven to be the most important, associated with a prevalence of 35%-65% 15,24 and a risk ratio of 3.4 for this type of injury. 26 With regard to vacuum deliveries, studies that have evaluated the association between the use of this instrument and levator ani muscle lesions are contradictory. 26 With regard to vacuum deliveries, studies that have evaluated the association between the use of this instrument and levator ani muscle lesions are contradictory.…”

Section: Introductionmentioning

confidence: 99%

“…25 A recent meta-analysis described an odds ratio (OR) of 7.02 (5.04-9.78) comparing delivery with forceps with normal delivery. 26,28,29 It must be taken into account that some of the studies published to date 24,25,30,31 include a small sample size, so obtaining a clear conclusion regarding this association can be difficult. Although some authors report a higher rate of injuries associated with vacuum deliveries than with normal vaginal deliveries, 27 other researchers have not found significant differences.…”

Section: Introductionmentioning

confidence: 99%

“…25 A recent meta-analysis described an odds ratio (OR) of 7.02 (5.04-9.78) comparing delivery with forceps with normal delivery. 26 With regard to vacuum deliveries, studies that have evaluated the association between the use of this instrument and levator ani muscle lesions are contradictory. Although some authors report a higher rate of injuries associated with vacuum deliveries than with normal vaginal deliveries, 27 other researchers have not found significant differences.…”

Section: Introductionmentioning

confidence: 99%

“…Although some authors report a higher rate of injuries associated with vacuum deliveries than with normal vaginal deliveries, 27 other researchers have not found significant differences. 26,28,29 It must be taken into account that some of the studies published to date 24,25,30,31 include a small sample size, so obtaining a clear conclusion regarding this association can be difficult.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Ta B L E 3 Levator Ani Muscle Injury and General Levator Hiamentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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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Predictive factors for time to cessation of urinary incontinence in primiparous adolescents after vaginal delivery

Babini

Lemos

2020

Intl J Gynecology & Obste

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Trends in instrument preference for operative vaginal delivery in a tertiary referral center: 2008–2021

Crowley

Lang

OʼLeary

et al. 2023

Intl J Gynecology & Obste

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Operative vaginal delivery (OVD) is a common procedure accounting for more than 10 000 vaginal deliveries per year in Ireland. 1 The goal of OVD is to expedite delivery for fetal distress or prolonged second stage of labor. Historically, forceps were used exclusively to perform OVD, although with the advent of vacuum devices in the 1950s, there has been a steady decrease in the use of forceps. 2 Despite these advances, OVD remains a technically challenging procedure and is associated with both maternal and perinatal morbidity.Vacuum-assisted deliveries are associated with higher rates of fetal trauma and failure, 3 while forceps-assisted delivery is associated with increased risk of perineal trauma leading to potential long-term pelvic symptoms or fecal incontinence. 3 The Royal College of Obstetricians & Gynaecologists recommend that clinicians select an instrument based on the clinical circumstances and skill level of the operator. 4 Several studies examining OVD trends in Irish maternity units found variation in OVD practice throughout the country. [5][6][7] Ideally, clinicians should strive to maintain an adequate level of skill in performing both types of instrumental deliveries to adapt to each clinical situation.The current study aimed to examine the trend in the ratio of vacuum to forceps-assisted deliveries, over 15 years in a large tertiary referral center.

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Delivery mode and the risk of levator muscle avulsion: a meta-analysis

Cited by 64 publications

References 42 publications

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

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

Predictive factors for time to cessation of urinary incontinence in primiparous adolescents after vaginal delivery

Trends in instrument preference for operative vaginal delivery in a tertiary referral center: 2008–2021

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