OBJECTIVES: 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.
OBJECTIVES: 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.
Authors: Victoria L Handa; Jennifer Roem; Joan L Blomquist; Hans Peter Dietz; Alvaro Muñoz Journal: Am J Obstet Gynecol Date: 2019-03-15 Impact factor: 8.661
Authors: Pamela S Fairchild; Lisa Kane Low; Katherine M Kowalk; Giselle E Kolenic; John O DeLancey; Dee E Fenner Journal: Int Urogynecol J Date: 2019-12-04 Impact factor: 2.894
Authors: Cristina Molinet Coll; Eva Martínez Franco; Laura Altimira Queral; Daniel Cuadras; Lluís Amat Tardiu; David Parés Journal: Reprod Sci Date: 2022-04-26 Impact factor: 2.924
Authors: Wenjin Cheng; Emily English; Whitney Horner; Carolyn W Swenson; Luyun Chen; Fernanda Pipitone; James A Ashton-Miller; John O L DeLancey Journal: Int Urogynecol J Date: 2022-09-21 Impact factor: 1.932
Authors: W Thomas Gregory; Alison G Cahill; Candice Woolfolk; Jerry L Lowder; Aaron B Caughey; Sindhu K Srinivas; Alan T N Tita; Methodius G Tuuli; Holly E Richter Journal: Am J Obstet Gynecol Date: 2022-02-22 Impact factor: 10.693
Authors: Emily M English; Luyun Chen; Anne G Sammarco; Giselle E Kolenic; Wenjin Cheng; James A Ashton-Miller; John O DeLancey Journal: Int Urogynecol J Date: 2021-01-05 Impact factor: 1.932
Authors: Carlijn F A Smeets; Tineke F M Vergeldt; Kim J B Notten; Frank M J Martens; Sander M J van Kuijk Journal: Int J Gynaecol Obstet Date: 2021-01-16 Impact factor: 3.561