OBJECTIVES: Levator avulsion has been shown to be associated with anterior and central compartment prolapse and is a risk factor for prolapse recurrence.
Diagnosis in Delivery Suite is usually impossible as levator avulsion is commonly occult. The objective of the study was to determine if vaginal and major perineal tears are clinical markers for levator trauma as diagnosed by 4 dimensional translabial ultrasound at 3-6 months postpartum.
METHODS:This is a retrospective observational study using data obtained in two perinatal trials. 774 women seen 3 to 6 months after their first birth of a term singleton cephalic baby had undergone a standardised interview, clinical assessment and 4 dimensional translabial ultrasound. Clinical data was obtained from the institutional obstetric database, including information on vaginal and perineal tears. Levator avulsion was diagnosed using tomographic ultrasound blinded to clinical data.
RESULTS: Both 3rd/4th degree perineal tears and vaginal sidewall tears are independently associated with levator avulsion (p = 0.004 and 0.012 respectively). The odds ratio for avulsion in women suffering from such overt trauma was 3.44 (confidence interval 1.47-8.03) for 3rd /4th degree perineal tears and 3.35 (confidence interval 1.30-8.61) for vaginal sidewall tears.
CONCLUSIONS: Sidewall vaginal and 3rd /4th degree perineal tears are found to be independent clinical indicators of increased risk of levator trauma as diagnosed by 4 dimensional translabial ultrasound at 3-6 months postpartum. Such clinical markers may become useful in the identification of women at high risk of levator trauma and future pelvic floor disorders.
Written by:
Shek KL, Green K, Hall J, Guzman-Rojas R, Dietz HP. Are you the author?
Department of Obstetrics and Gynaecology, Liverpool Clinical School, University of Western Sydney, Australia; Department of Obstetrics and Gynaecology, Nepean Clinical School, University of Sydney, Australia.
Reference: Ultrasound Obstet Gynecol. 2015 Mar 25. Epub ahead of print.
doi: 10.1002/uog.14856
PubMed Abstract
PMID: 25807920