Factors associated with anal sphincter laceration in 40,923 primiparous women

Baumann, P.; Hammoud, Ahmad; McNeeley, S. Gene; DeRose, Elizabeth; Kudish, Bela; Hendrix, Susan L.

doi:10.1007/s00192-006-0274-8

Cited by 53 publications

(27 citation statements)

References 39 publications

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“…Whilst some authors have found a reduction in the rate of OASI with epidural analgesia [53][54][55], others have found no difference [12,41]. Roos et al [56] found that epidural analgesia was the only independent factor that predicted OASI.…”

Section: Epidural Analgesiamentioning

confidence: 99%

Obstetric anal sphincter injuries: review of anatomical factors and modifiable second stage interventions

2015

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Section: Epidural Analgesiamentioning

confidence: 99%

Obstetric anal sphincter injuries: review of anatomical factors and modifiable second stage interventions

2015

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“…Curiously, these authors found that patients with a BMI less than 30 kg/m 2 had a greater chance of avulsion, and they hypothesized that nutritional status was related to this protective biomechanical effect of the pelvic muscles. However, their finding is still considered inconclusive 17,21 . Despite the small number of cases included in this study, 66% of the patients with levator ani muscle avulsion had a BMI less than 30 kg/m 2 , which coincide with the already presented data.…”

Section: Discussionmentioning

confidence: 96%

Assessment of pelvic floor by three-dimensional-ultrasound in primiparous women according to delivery mode: initial experience from a single reference service in Brazil

Júnior

Freitas

Bella

et al. 2013

Rev. Bras. Ginecol. Obstet.

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Assessment of pelvic floor by threedimensional-ultrasound in primiparous women according to delivery mode: initial experience from a single reference service in Brazil Abstract PURPOSE: To evaluate changes to the pelvic floor of primiparous women with different delivery modes, using three-dimensional ultrasound. METHODS: A prospective cross-sectional study on 35 primiparae divided into groups according to the delivery mode: elective cesarean delivery (n=10), vaginal delivery (n=16), and forceps delivery (n=9). Three-dimensional ultrasound on the pelvic floor was performed on the second postpartum day with the patient in a resting position. A convex volumetric transducer (RAB4-8L) was used, in contact with the large labia, with the patient in the gynecological position. Biometric measurements of the urogenital hiatus were taken in the axial plane on images in the rendering mode, in order to assess the area, anteroposterior and transverse diameters, average thickness, and avulsion of the levator ani muscle. Differences between groups were evaluated by determining the mean differences and their respective 95% confidence intervals. The proportions of levator ani muscle avulsion were compared between elective cesarean section and vaginal birth using Fisher's exact test. RESULTS: The mean areas of the urogenital hiatus in the cases of vaginal and forceps deliveries were 17.0 and 20.1 cm 2 , respectively, versus 12.4 cm 2 in the Control Group (elective cesarean). Avulsion of the levator ani muscle was observed in women who underwent vaginal delivery (3/25), however there was no statistically significant difference between cesarean section and vaginal delivery groups (p=0.5). CONCLUSION: Transperineal three-dimensional ultrasound was useful for assessing the pelvic floor of primiparous women, by allowing pelvic morphological changes to be differentiated according to the delivery mode. ResumoOBJETIVO: Avaliar as mudanças no assoalho pélvico de mulheres primíparas em diversos tipos de partos por meio da ultrassonografia tridimensional. MÉTODOS: Estudo de corte transversal prospectivo com 35 primigestas, divididas em grupos com relação ao tipo de parto: cesariana eletiva (n=10), parto vaginal (n=16) e fórceps (n=9). A ultrassonografia tridimensional do assoalho pélvico foi realizada no segundo dia pós-parto com a paciente em repouso. Utilizou-se transdutor convexo volumétrico (RAB4-8L) em contato com os grandes lábios vaginais, estando a paciente em posição ginecológica. Medidas biométricas do hiato urogenital foram tomadas no plano axial da imagem renderizada para avaliar a área, os diâmetros anteroposterior e transverso, a espessura média e a avulsão do músculo elevador do ânus. Diferenças entre os grupos foram avaliadas pela determinação da média das diferenças com seus respectivos intervalos de confiança de 95%. As proporções de avulsão do músculo elevador do ânus foram comparadas entre a cesárea eletiva e o parto vaginal pelo teste exato de Fisher. RESULTADOS: As áreas médias do hiato urogenital dos partos vaginais e ...

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“…While the literature supports overweight as a risk factor for pelvic organ prolapse [23], other studies show a protective effect of higher BMI level on pelvic floor injury [24, 25]. …”

Section: Discussionmentioning

confidence: 99%

Contribution of Primary Pelvic Organ Prolapse to Micturition and Defecation Symptoms

Groenendijk

Birnie²,

Roovers

et al. 2012

Obstetrics and Gynecology International

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Objective. To investigate the contribution of Pelvic Organ Prolapse (POP) to micturition and defecation symptoms. Method. Cross-sectional study including 64 women presenting with POP symptoms and 50 controls without POP complaints. Subjects were evaluated using POP-Quantification system, Urinary Distress Inventory, and Defecation Distress Inventory. The MOS SF-36 health survey and the Center for Epidemiological Studies Depression scale were used to measure self-perceived health status and depressive symptoms, respectively. Results. POP in terms of POP-Q had a moderate impact on the symptom observing vaginal protrusion (explained variance 0.31). It contributed modestly to obstructive voiding and overactive bladder symptoms (explained variance 0.09, resp., 0.14) but not to urinary incontinence. Constipation was more likely explained by clinical depression than by pelvic floor defects (explained variance 0.13, resp., 0.05). Conclusion. Stage of POP and specific prolapse symptoms are associated but such a strong association does not exist between POP and micturition or defecation symptoms.

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Factors associated with anal sphincter laceration in 40,923 primiparous women

Cited by 53 publications

References 39 publications

Obstetric anal sphincter injuries: review of anatomical factors and modifiable second stage interventions

Obstetric anal sphincter injuries: review of anatomical factors and modifiable second stage interventions

Assessment of pelvic floor by three-dimensional-ultrasound in primiparous women according to delivery mode: initial experience from a single reference service in Brazil

Contribution of Primary Pelvic Organ Prolapse to Micturition and Defecation Symptoms

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