Levator Ani Muscle (LAM) injuries occur in 13 to 36% of women who have a vaginal delivery delivery.
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Although these injuries were first described using Magnetic Resonance Imaging, 3D transperineal and endovaginal ultrasound has emerged as a more readily available and economic alternative to identify LAM morphology. Injury to the LAM is attributed to vaginal delivery resulting in reduced pelvic floor muscle strength, enlargement of the vaginal hiatus and pelvic organ prolapse. There is inconclusive evidence to support an association between LAM injuries and stress urinary incontinence and there seems to be a trend towards development of faecal incontinence. Longitudinal studies with long term follow-up assessing the LAM before and after childbirth are lacking. Furthermore, the consequence of LAM injuries on quality of life due to prolapse and/or urinary and faecal incontinence have not been evaluated using validated questionnaires. Direct comparative studies using the imaging modalities (MRI and 3D endovaginal/ - transperineal ultrasound) are needed to determine the true gold standard for the diagnosis of LAM injuries. This would enable consistency in definition and classification of LAM injuries. Only then can high risk groups be identified and preventative strategies implemented in obstetric practice.
Schwertner-Tiepelmann N, Thakar R, Sultan AH, Tunn R. Are you the author?
Croydon University Hospital, 530 London Road, Croydon, CR7 7YE, UK.
Reference: Ultrasound Obstet Gynecol. 2011 Dec 20. Epub ahead of print.