Recommended standardized terminology of the anterior female pelvis based on a structured medical literature review

Jeppson, Peter C.; Balgobin, Sunil; Washington, Blair B.; Hill, Audra Jolyn; Lewicky-Gaupp, Christina; Wheeler, Thomas L.; Ridgeway, Beri; Mazloomdoost, Donna; Balk, Ethan M; Corton, Marlene M.; DeLancey, John O.L.

doi:10.1016/j.ajog.2018.04.006

Cited by 21 publications

(25 citation statements)

References 186 publications

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“…27 Volumes for each woman were obtained at rest, at maximum contraction and under the Valsalva maneuver. Levator hiatus measurements, 35 transverse diameter, antero-posterior diameter and area were studied in the plane of minimal hiatal dimensions, as also described in previous papers. 36 Using the multi-view mode, a complete avulsion was diagnosed when an abnormal muscle insertion was identified in all three central slices, that is, in the minimal hiatal dimensions and the 2.5 and 5.0 mm slices cranial to this one ( Figure 1).…”

Section: Key Messagementioning

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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Section: Key Messagementioning

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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“…The plane of minimal hiatal dimensions (PMD), determined based on the minimum distance between the hyperechoic posterior part of the pubic symphysis and the hyperechoic anterior margin of the LAM just posterior to the anorectal muscle, was used for offline ultrasound analysis and examinations of levator hiatus measurements. 2 Levator hiatus measurements, 15,16 transverse diameter, anteroposterior diameter, and area, were studied in the PMD, as also reported in previous papers. 19 Overdistention (ballooning) was defined as a levator hiatus area ≥ 25 cm 2 on Valsalva 7 (Figure 1).…”

Section: Methodsmentioning

confidence: 89%

Prevalence of levator hiatal overdistension after vacuum and forceps deliveries

Bueno

González-Díaz

Martínez

et al. 2020

Neurourology and Urodynamics

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Introduction: Levator ani avulsion rates after assisted vaginal delivery have been reported in the literature. However, there are no definitive data regarding the association between overdistention and assisted vaginal delivery. Therefore, our aim is to report overdistention rates after assisted vaginal delivery with a postpartum ultrasound examination. Materials and Methods:This multicenter study involved a retrospective analysis of data from primiparous women (n = 602) who had previously been recruited at three tertiary hospitals between January 2015 and January 2017. Overdistention was assessed at 6 months postpartum using three-/four-dimensional transperineal ultrasound. Patients with levator ani muscle avulsion were excluded. Overdistention was defined as a levator hiatal area ≥ 25 cm 2 on Valsalva.Results: Of the 602 primiparous patients, 250 patients who satisfied the inclusion criteria (139 patients who underwent forceps delivery and 111 patients who underwent vacuum delivery) were evaluated. Overdistention occurred in 20% (50 of 250) of these patients. Overdistention was observed for 1% (1/111) of vacuum deliveries and 35.3% (49 of 139) of forceps deliveries. We found an increased risk of overdistention following forceps delivery compared to vacuum delivery, with a crude odds ratio (OR) of 59.9 (95% confidence interval [CI]: 8.1, 442.2) and an adjusted OR (adjusted for maternal age, second-stage duration, and head circumference) of 17.6 (95% CI: 2.3, 136.7).Conclusions: Postpartum overdistention occurred for 20% of assisted vaginal deliveries, with an increased risk of overdistention following forceps delivery compared to vacuum delivery. K E Y W O R D S3D transperineal ultrasound, forceps delivery, levator ani muscle, overdistention, vacuum delivery

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“…The SGS Pelvic Anatomy Group consists of gynecologic surgeons with extensive clinical, anatomic, surgical, and imaging expertise pertinent to the female pelvis, as well as physicians with considerable experience with systematic review methodologies. Similar to the previous work on the anterior female pelvis, 8 the literature was systematically searched and evaluated for anatomic terms relevant to the apical segment of the female pelvis. The apical segment was broadly defined to include the female reproductive organs (uterus, cervix, tubes, ovaries) and associated ligaments; the upper vagina; DeLancey level 1 support structures 11 ; the distal ureters from the pelvic brim to bladder insertion; and connective tissues, vessels, lymphatics, and nerves from these structures laterally to the pelvic bones.…”

Section: Methodsmentioning

confidence: 99%

“…Terminologia Anatomica 6 was published in 1998 as the international reference standard of anatomic terms and was updated in 2011. 7 As was discussed in the prior work by this group, 8 this publication represents the culmination of more than a century of work by hundreds of anatomists and is the current international reference on human anatomical terminology. However, it has several limitations that preclude its complete integration into current practice.…”

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confidence: 98%

“…Recommended standardized terminology for the anterior pelvic compartment was recently published by our group. 8 This current study focuses on the apical segment of the female pelvis, which comprises the superior vagina, female reproductive organs, and DeLancey Level 1 connective tissue structures and their contents. 11,12 Anatomic understanding and unambiguous communication about these structures is essential for diagnosis and treatment of diseases of the female reproductive tract and pelvic floor, and for the successful performance of gynecologic surgical procedures.…”

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confidence: 99%

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Standardized terminology of apical structures in the female pelvis based on a structured medical literature review

Balgobin

Jeppson

Wheeler

et al. 2020

American Journal of Obstetrics and Gynecology

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Recommended standardized terminology of the anterior female pelvis based on a structured medical literature review

Cited by 21 publications

References 186 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

Prevalence of levator hiatal overdistension after vacuum and forceps deliveries

Standardized terminology of apical structures in the female pelvis based on a structured medical literature review

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