Pelvic Floor Disorders after Obstetric Avulsion of the Levator Ani Muscle

Victoria L Handa, Joan L. Blomquist, Jennifer Roem, Alvaro Munoz, Hans Peter Dietz

Research output: Contribution to journalArticle

Abstract

With vaginal childbirth, 10% to 30% of women sustain levator ani muscle avulsion. The objective of this study was to estimate the cumulative incidence of prolapse and other pelvic floor disorders (PFDs), comparing vaginally parous women with and without levator avulsion. Methods Parous women enrolled in a longitudinal study were assessed annually for PFDs with the Pelvic Organ Prolapse Quantification Examination (for prolapse) and the Epidemiology of Prolapse and Incontinence Questionnaire (for stress incontinence, overactive bladder, and anal incontinence). Three-dimensional transperineal ultrasound was used to identify levator avulsion. Women with and without levator avulsion after vaginal delivery were compared for the cumulative incidence of PFDs. Further analysis also stratified by forceps delivery. Results At the time of assessment, 453 participants were 6 to 17 years from first delivery (median, 11 years). Levator avulsion was identified in 15% (66/453) and was more common among those who had undergone forceps-assisted delivery (P < 0.001). Levator avulsion was strongly associated with prolapse beyond the hymen (odds ratio, 2.7; 95% confidence interval, 1.3-5.7) and with symptoms of prolapse (odds ratio, 3.0; 95% confidence interval-1.2, 7.3). These associations persisted after controlling for forceps-assisted delivery. In contrast, the odds of stress incontinence, overactive bladder, and anal incontinence were marginally (but not significantly) increased among women with levator avulsion in this cohort. Conclusions Obstetric levator avulsion is strongly associated with pelvic organ prolapse. The relationship between levator avulsion and other PFDs may not be significant.

Original languageEnglish (US)
Pages (from-to)8-14
Number of pages7
JournalFemale Pelvic Medicine and Reconstructive Surgery
Volume25
Issue number1
DOIs
StatePublished - Jan 1 2019

Fingerprint

Pelvic Floor Disorders
Prolapse
Anal Canal
Obstetrics
Muscles
Surgical Instruments
Pelvic Organ Prolapse
Overactive Urinary Bladder
Hymen
Odds Ratio
Confidence Intervals
Incidence
Longitudinal Studies
Epidemiology
Parturition

Keywords

  • forceps-assisted vaginal delivery
  • obstetric levator ani avulsion
  • pelvic organ prolapse

ASJC Scopus subject areas

  • Surgery
  • Obstetrics and Gynecology
  • Urology

Cite this

Pelvic Floor Disorders after Obstetric Avulsion of the Levator Ani Muscle. / Handa, Victoria L; Blomquist, Joan L.; Roem, Jennifer; Munoz, Alvaro; Dietz, Hans Peter.

In: Female Pelvic Medicine and Reconstructive Surgery, Vol. 25, No. 1, 01.01.2019, p. 8-14.

Research output: Contribution to journalArticle

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abstract = "With vaginal childbirth, 10{\%} to 30{\%} of women sustain levator ani muscle avulsion. The objective of this study was to estimate the cumulative incidence of prolapse and other pelvic floor disorders (PFDs), comparing vaginally parous women with and without levator avulsion. Methods Parous women enrolled in a longitudinal study were assessed annually for PFDs with the Pelvic Organ Prolapse Quantification Examination (for prolapse) and the Epidemiology of Prolapse and Incontinence Questionnaire (for stress incontinence, overactive bladder, and anal incontinence). Three-dimensional transperineal ultrasound was used to identify levator avulsion. Women with and without levator avulsion after vaginal delivery were compared for the cumulative incidence of PFDs. Further analysis also stratified by forceps delivery. Results At the time of assessment, 453 participants were 6 to 17 years from first delivery (median, 11 years). Levator avulsion was identified in 15{\%} (66/453) and was more common among those who had undergone forceps-assisted delivery (P < 0.001). Levator avulsion was strongly associated with prolapse beyond the hymen (odds ratio, 2.7; 95{\%} confidence interval, 1.3-5.7) and with symptoms of prolapse (odds ratio, 3.0; 95{\%} confidence interval-1.2, 7.3). These associations persisted after controlling for forceps-assisted delivery. In contrast, the odds of stress incontinence, overactive bladder, and anal incontinence were marginally (but not significantly) increased among women with levator avulsion in this cohort. Conclusions Obstetric levator avulsion is strongly associated with pelvic organ prolapse. The relationship between levator avulsion and other PFDs may not be significant.",
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