Evaluation of levator ani muscle throughout the different stages of labor by transperineal 3D ultrasound

García‐Mejido, José Antonio; Suárez-Serrano, Carmen; Palacín, Ana Fernéndez; Pino, Adriana Aquise; Barby, María José Bonomi; Bueno, José Antonio Sainz

doi:10.1002/nau.23175

Cited by 25 publications

(24 citation statements)

References 32 publications

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“…We observed that deliveries with disengagement of the branches of the forceps before extraction of the fetal head show a similar rate of LAM avulsion with an adjusted OR (without disengagement vs with disengagement) of 0.82 (95% CI 0.40‐1.69; P = 0.603). Hence, in deliveries without disengagement, we did not identify any statistically significant increase in the rate of LAM injuries due to the increase in the levator hiatus area because of the association of the fetal head and forceps during the passage of the fetal head at the level of the LAM, during which women are more susceptible to injuries . The increase in the area of the hiatus during the passage of the fetal head in cases of non‐disengagement of the forceps may also suggest the hiatal overdistensibility (microtrauma) that we observed in our study in cases of non‐disengagement …”

Section: Discussionmentioning

confidence: 62%

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Influence of the disengagement of the forceps on levator ani muscle injuries in instrumental delivery: A multicenter study

Bueno

Martín‐Martinez

González-Díaz

et al. 2019

Acta Obstet Gynecol Scand

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Introduction Forceps use is the main risk factor for levator ani muscle (LAM) injuries. We believe that the disengagement of the forceps branches before delivery of the fetal head could influence LAM injuries, so we aimed to determine the influence of the disengagement of the forceps on the occurrence of LAM avulsion during forceps delivery. Material and methods A prospective, observational, multicenter study was conducted with 261 women who underwent forceps delivery. The women were classified according to whether the branches of the forceps had been disengaged before delivery of the fetal head. LAM avulsion was defined using a multislice mode (3 central slices). Results In all, 255 women completed the study (160 without disengagement and 95 with disengagement). LAM avulsions were observed in 37.9% of women in the group with disengagement and in 41.9% of women in the group without disengagement. The crude OR (without disengagement vs with disengagement) for avulsion was 0.90 (95% CI 0.49‐1.67, P = 0.757) and an adjusted OR of 0.82 (95% CI 0.40‐1.69, P = 0.603). Conclusions We did not observe a statistically significant reduction in the LAM avulsion rate with disengagement of the forceps branches before delivery of the fetal head.

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Section: Discussionmentioning

confidence: 62%

“…The most critical time for LAM avulsion is when the fetal head reaches the perineum and the levator hiatus area is largest . We believe in the importance of caution at this time and the least trauma possible.…”

Section: Introductionmentioning

confidence: 92%

Influence of the disengagement of the forceps on levator ani muscle injuries in instrumental delivery: A multicenter study

Bueno

Martín‐Martinez

González-Díaz

et al. 2019

Acta Obstet Gynecol Scand

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“…40 The levator ani muscle injury rate in vacuum deliveries described in this paper is similar to that described in our previous studies. As we believe that crowning is the moment at which levator injury is more likely to be produced, 18 special care was taken at this moment of the delivery. No significant differences were observed between the rate of levator ani muscle injury after vacuum deliveries and forceps deliveries.…”

Section: Malmström Vacuum and Kielland Forceps Deliveriesmentioning

confidence: 99%

“…16 These alterations, associated with a decrease in strength and with age-related fibrosis, represent the probable mechanisms for pelvic floor muscle dysfunction in elderly women. 18 The levator ani muscle manages to stretch more than three times its usual length to allow the exit of the fetal head. 18 The levator ani muscle manages to stretch more than three times its usual length to allow the exit of the fetal head.…”

Section: Introductionmentioning

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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“…The pelvic floor undergoes a series of changes during labour that can lead to the avulsion of the levator ani muscle (LAM) . This traumatic disconnection of LAM from its insertion at the pubic level causes the muscle to become more distensible and less contractile .…”

Section: Introductionmentioning

confidence: 99%

The correlation between the type of forceps application and the rate of levator ani muscle avulsion: A prospective cohort study

García‐Mejido

Pino

Fernández-Palacín

et al. 2018

Neurourology and Urodynamics

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Evaluation of levator ani muscle throughout the different stages of labor by transperineal 3D ultrasound

Cited by 25 publications

References 32 publications

Influence of the disengagement of the forceps on levator ani muscle injuries in instrumental delivery: A multicenter study

Influence of the disengagement of the forceps on levator ani muscle injuries in instrumental delivery: A multicenter study

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

The correlation between the type of forceps application and the rate of levator ani muscle avulsion: A prospective cohort study

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