Multicenter study of the evolution of different types of avulsion over the 12 months after delivery

García‐Mejido, José Antonio; González-Díaz, Enrique; Ortega, Ismael; Martín‐Martinez, Alicia; Fernández‐Palacín, Ana; Bueno, José Antonio Sainz

doi:10.1002/ijgo.14208

Cited by 3 publications

(1 citation statement)

References 30 publications

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“…Problems with the diagnosis of avulsion can arise when there is clearly a deficiency of muscle on the inferior pubic ramus, but still a visible hyperechogenic connection between muscle and bone. This condition has been termed as 'type I' avulsion, as opposed to a 'type II' avulsion in which there is no such connection visible 20 . Although it seems unlikely that this distinction is valid 21 , the fact remains that there are many women with partial avulsion 22 , and sometimes it is difficult to distinguish between partial and complete avulsion.…”

Section: Introductionmentioning

confidence: 99%

Levator–urethra gap: is there a need for individualization of cut‐offs?

Dietz,

Shek,

Descallar

2024

Ultrasound in Obstet & Gyne

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ObjectiveTo determine whether age, height, weight and BMI are associated with the levator urethra gap measurement, and whether these factors confound the relationship between LUG and symptoms and signs of POP.MethodsRetrospective study of women seen at a tertiary urogynecology unit between January 2020 and December 2021. Postprocessing of saved ultrasound volume data was utilised to measure the levator‐ urethra gap, blinded against all other data. This measurement was tested for its association with organ descent and hiatal area, and height, weight and body mass index were investigated for any potential confounding effect.ResultsThe 624 women seen during the inclusion period presented mostly with stress urinary incontinence (448, 72%), urgency urinary incontinence (469, 75%) and/ or prolapse (338, 54%). Mean age at assessment was 58 (range, 20‐94) years, mean height was 163 (range, 142‐182) cm, mean weight 80 (41‐ 153) kg, mean BMI was 30 (17‐65) kg/m2. LUG measurements could be obtained in 613 women, resulting in 12*613= 7356 measurements. The average LUG in individual women was 2.35 cm on the right and 2.32 cm on the left (n.s.), for an average of 2.34 cm (SD 0.63) overall. Mean LUG was associated with symptoms and signs of prolapse, both on POPQ and on imaging, but not with height (P= 0.36), weight (P= 0.2) or BMI (P= 0.09).ConclusionLevator‐ urethra gap measurements do not seem to be associated with height, weight or BMI in our population, obviating the need for individualisation of LUG. However, this does not exclude interethnic variability of this biometric measure.This article is protected by copyright. All rights reserved.

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Section: Introductionmentioning

confidence: 99%

Levator–urethra gap: is there a need for individualization of cut‐offs?

Dietz,

Shek,

Descallar

2024

Ultrasound in Obstet & Gyne

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Multicenter study of the evolution of different types of avulsion over the 12 months after delivery

García‐Mejido

González-Díaz

Ortega

et al. 2022

Intl J Gynecology & Obste

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Levator ani muscle (LAM) avulsion is defined as detachment of the fibers of the LAM from the muscle's insertion at the level of the inferior pubic branch. 1 Its occurrence is related to different pathologies of the pelvic floor, such as pelvic organ prolapse, 2,3 voiding dysfunction, 4 and relapse after prolapse correction surgery. 5 However, its association with stress urinary incontinence is not as evident. 6 LAM avulsion is intimately related to vaginal delivery, 7 occurring when the vertex of the fetal head is at station +3 to +4. 8,9

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Do some levator avulsions improve over time?

Dietz,

Shek,

Descallar

2024

Ultrasound in Obstet & Gyne

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ObjectiveTo determine whether the sonographic appearance of levator avulsion after vaginal childbirth can improve significantly over the first few years postpartum.MethodsRetrospective study of women seen in the context of two prospective perinatal imaging studies. All subjects had undergone an interview, clinical examination and 4D translabial ultrasound (TLUS) on average 4.3 months and 3.1 years post‐partum. Volume data sets were analysed at a later date blinded against all other data. The number of abnormal slices at both time points was compared using Mann‐ Whitney U Test. Patients in whom findings had changed over time were reviewed separately in parallel in order to reduce the impact of differences in slice location and imaging settings. The symmetry test was used to analyse changes between the two postnatal visits.ResultsOf 1148 women originally recruited, 315 had had at least two postnatal visits. 42 were excluded, leaving 273 women for analysis. They were first seen on average 4.3 (2.6‐9.8) months after childbirth and the last time 3.1 (1.4‐8) years postpartum. Cohen's kappa for the two assessments was 0.89, with agreement in 97% (264/273) of cases. At the first visit, complete avulsion was diagnosed in 20, partial avulsion in 32, and no avulsion in 221. While seven partial avulsions appeared sonographically normal at the second visit, there were no statistically significant changes in avulsion category between visits (P=0.4).ConclusionTomographic pelvic floor imaging obtained 2.5‐10 months after childbirth may be used as a proxy for long‐ term outcomes. Findings at a mean of 3.1 years showed 97% agreement with imaging obtained at an average of 4.3 months. There was a non‐significant reduction in abnormal slices affecting at most 3/12 slices. This may be explained by compensatory hypertrophy of remaining intact muscle. Sonographic normalisation of complete avulsion was not observed.This article is protected by copyright. All rights reserved.

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Multicenter study of the evolution of different types of avulsion over the 12 months after delivery

Cited by 3 publications

References 30 publications

Levator–urethra gap: is there a need for individualization of cut‐offs?

Levator–urethra gap: is there a need for individualization of cut‐offs?

Multicenter study of the evolution of different types of avulsion over the 12 months after delivery

Do some levator avulsions improve over time?

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