Effect of Levator Ani Muscle Injury on Primiparous Women During the First Year After Childbirth

Chan, Symphorosa S. C.; Cheung, Ray C. C.; Yiu, K W; Lee, L. L.; Chung, Tony K.H.

doi:10.1097/ogx.0000000000000145

Cited by 16 publications

(42 citation statements)

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“…Although a positive association between LAM injury and urinary incontinence was found, the relationship could not be drawn clearly. We were not able to confirm that LAM injury was related to these symptoms of pelvic floor disorder or had an adverse impact on quality of life at 8 weeks' postpartum, which is consistent with previous findings. Additionally, symptoms may arise later; the mean latency period between the first vaginal delivery and the presentation of pelvic organ prolapse is 34.3 (range, 3–66.3) years in women with LAM injury.…”

Section: Discussionsupporting

confidence: 51%

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

Chung

Wan

Cheung

et al. 2015

Ultrasound Obstet Gynecol

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Section: Discussionsupporting

confidence: 51%

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

Chung

Wan

Cheung

et al. 2015

Ultrasound Obstet Gynecol

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“…In our study, the prevalence of major levator ani muscle defects among women with vaginal deliveries and second‐stage caesarean sections was 18.8%. The number is within the range found in other studies using ultrasonography or magnetic resonance imaging, which show prevalences of between 13 and 38.5% of major levator ani muscle defects in primiparous women who delivered vaginally . We chose not to exclude women with second‐stage caesarean sections from our analysis.…”

Section: Discussionmentioning

confidence: 84%

The levator ani muscle during pregnancy and major levator ani muscle defects diagnosed postpartum: a three‐ and four‐dimensional transperineal ultrasound study

Siafarikas

Stær-Jensen

Hilde

et al. 2015

BJOG

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Objective To investigate associations between levator hiatus area and levator ani muscle function during pregnancy and major levator ani muscle defects postpartum.Design Observational prospective cohort study.Setting University hospital, Norway.Sample A cohort of 234 nulliparous women at 21 and 37 weeks of gestation, and at 6 weeks postpartum.Methods Ultrasound measurements of the levator hiatus at rest, during pelvic floor muscle contraction, and during the Valsalva manoeuvre were taken at 21 and 37 weeks of gestation. Levator ani muscle function was estimated as the percentage changes in levator ani muscle length from rest to contraction, and the level of muscle stretch during the Valsalva manoeuvre. Major levator ani muscle defects were diagnosed at 6 weeks postpartum using tomographic ultrasound imaging.Main outcome measures Associations between ultrasound measurements antepartum and major levator ani muscle defects postpartum.Results Women with major levator ani muscle defects postpartum had significantly smaller levator hiatus area at rest and during the Valsalva manoeuvre at mid-pregnancy (mean difference 1.03 cm 2 , 95% CI 0.31-1.76; 2.92 cm 2 , 95% CI 1.77-4.07), and at 37 weeks of gestation (mean difference 1.47 cm 2 , 95% CI 0.62-2.32; 2.84 cm 2 , 95% CI 0.88-4.80), than women without such defects.They also had significantly less shortening of the levator ani muscle during contraction at 37 weeks of gestation.Conclusions Smaller levator hiatus area at rest and during the Valsalva manoeuvre at mid and late pregnancy, and less shortening of the levator ani muscle during contraction at 37 weeks of gestation, are associated with major levator ani muscle defects postpartum.Keywords Levator hiatus, major levator ani muscle defects, pregnancy, transperineal ultrasound.Please cite this paper as: Siafarikas F, Staer-Jensen J, Hilde G, Bø K, Ellström Engh M. The levator ani muscle during pregnancy and major levator ani muscle defects diagnosed postpartum: a three-and four-dimensional transperineal ultrasound study.

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“…7,8,11 To our knowledge, only a few studies have investigated the change in prevalence of major LAM defects up to 1 year after delivery. 7,12 These studies have limitations in terms of high losses to follow up.…”

Section: Introductionmentioning

confidence: 99%

Change in prevalence of major levator ani muscle defects from 6 weeks to 1 year postpartum, and maternal and obstetric risk factors: A longitudinal ultrasound study

Halle

Stær-Jensen

Hilde

et al. 2020

Acta Obstet Gynecol Scand

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Introduction The present study aimed first to investigate the change in prevalence of major levator ani muscle (LAM) defects, also called avulsions, from 6 weeks to 1 year postpartum, and second to assess maternal and obstetric risk factors for having persistent major LAM defects/avulsions at 1 year postpartum. Material and methods This is a secondary analysis of data from a prospective cohort study including 300 nulliparous women at 17‐19 weeks of gestation. Major LAM defects were diagnosed at 6 weeks and 1 year postpartum using transperineal ultrasonography. We defined persistent major LAM defects as a defect diagnosed both at 6 weeks and 1 year postpartum. Maternal and obstetric data were obtained from the hospital’s electronic birth records. Pelvic floor muscle function was measured vaginally by manometer at 21 weeks of gestation. The main outcome measurement was change in prevalence of major LAM defects. Maternal and obstetric risk factors for having persistent major LAM defect were also assessed. Results Prevalence of major LAM defects was 19.4% at 6 weeks and 10.4% at 1 year postpartum. No new major LAM defects were diagnosed at 1 year postpartum. Persisting major LAM defects were associated with longer second stage of labor (median 74.5 minutes vs median 48.0 minutes, P = .012) and higher neonatal birthweight (mean difference of 232.3 g, 95% confidence interval [CI] 21.5‐443.1). Vacuum delivery was independently associated with persistent major LAM defects, adjusted OR 3.0 (95% CI 1.0‐9.0). Conclusions There was a 50% reduction of sonographically diagnosed major LAM defects from 6 weeks to 1 year postpartum. This finding suggests that assessment of the major LAM 6 weeks postpartum may be too early to diagnose defects/avulsions. Long second stage of labor, high neonatal birthweight and vacuum delivery were associated with persistent major LAM defects/avulsions.

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Effect of Levator Ani Muscle Injury on Primiparous Women During the First Year After Childbirth

Cited by 16 publications

References 0 publications

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

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

The levator ani muscle during pregnancy and major levator ani muscle defects diagnosed postpartum: a three‐ and four‐dimensional transperineal ultrasound study

Change in prevalence of major levator ani muscle defects from 6 weeks to 1 year postpartum, and maternal and obstetric risk factors: A longitudinal ultrasound study

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