Can pelvic floor trauma be predicted antenatally?
Acta Obstet Gynecol Scand
; 97(6): 751-757, 2018 Jun.
Article
em En
| MEDLINE
| ID: mdl-29393505
ABSTRACT
INTRODUCTION:
Levator trauma is a risk factor for the development of pelvic organ prolapse. We aimed to identify antenatal predictors for significant damage to the levator ani muscle during a first vaginal delivery. MATERIAL ANDMETHODS:
A retrospective observational study utilizing data from two studies with identical inclusion criteria and assessment protocols between 2005 and 2014. A total of 1148 primiparae with an uncomplicated singleton pregnancy were recruited and assessed with translabial ultrasound at 36 weeks antepartum and 871 (76%) returned for reassessment 3-6 months postpartum. The ultrasound data of vaginally parous women were analyzed for levator avulsion and microtrauma. The former was diagnosed if the muscle insertion at the inferior pubic ramus in the plane of minimal hiatal dimensions and within 5 mm above were abnormal on tomographic ultrasound imaging. Microtrauma was diagnosed in women with an intact levator and if there was a postpartum increase in hiatal area on Valsalva by >20% with the resultant area ≥25 cm2 .RESULTS:
The complete datasets of 844 women were analyzed. Among them, 609 delivered vaginally by normal vaginal delivery in 452 (54%), a vacuum birth in 102 (12%) and a forceps delivery in 55 (6%). Levator avulsion was diagnosed in 98 and microtrauma in 97. On multivariate analysis, increasing maternal age, lower body mass index and lower bladder neck descent were associated with avulsion. Increased bladder neck descent and a family history of cesarean section (CS) were associcated with microtrauma.CONCLUSIONS:
Maternal age, body mass index, bladder neck descent and family history of CS are antenatal predictors for levator trauma.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Ultrassonografia
/
Diafragma da Pelve
/
Complicações do Trabalho de Parto
Tipo de estudo:
Diagnostic_studies
/
Etiology_studies
/
Guideline
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Adolescent
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Adult
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Female
/
Humans
/
Middle aged
/
Pregnancy
País/Região como assunto:
Oceania
Idioma:
En
Revista:
Acta Obstet Gynecol Scand
Ano de publicação:
2018
Tipo de documento:
Article
País de afiliação:
Austrália