Intrapartum predictors of maternal levator ani injury

Jessica Caudwell-Hall, Ixora Kamisan @ Atan, Andrew Martin, Rodrigo Guzman Rojas, Susanne Langer, Kalai Shek, Hans P. Dietz

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Introduction: Damage to the pelvic floor during vaginal childbirth is common, and may take the form of levator avulsion or irreversible overdistension of the levator hiatus (microtrauma). Such trauma is a major risk factor for pelvic organ prolapse later in life. In this study we aimed to identify intrapartum risk factors for levator trauma. Material and methods: This is a retrospective analysis of data obtained in two perinatal studies on primiparous women. Between 2005 and 2014, 1148 women carrying an uncomplicated singleton pregnancy in the late third trimester were seen for 4D pelvic floor ultrasound and an interview. They were invited for a repeat assessment at three months postpartum. Results: Of 1148 women, 871 (76%) returned for assessment at a mean of five months postpartum. The datasets of 844 women were analyzed due to missing data or concurrent pregnancy in 27. In all, 452 (54%) had a normal vaginal delivery, 102 (12%) a vacuum, 55 (6%) a forceps, and 235 (28%) a cesarean section. On multivariate analysis forceps, length of second stage and obstetric anal sphincter tears were significantly associated with levator avulsion. There were no significant predictors identified for irreversible overdistension. Conclusions: The use of forceps, a prolonged second stage, and obstetric anal sphincter tears were associated with levator avulsion. There were no associated intrapartum predictors for hiatal overdistension.

Original languageEnglish
Pages (from-to)426-431
Number of pages6
JournalActa Obstetricia et Gynecologica Scandinavica
Volume96
Issue number4
DOIs
Publication statusPublished - 1 Apr 2017
Externally publishedYes

Fingerprint

Anal Canal
Mothers
Surgical Instruments
Pelvic Floor
Wounds and Injuries
Postpartum Period
Obstetrics
Pelvic Organ Prolapse
Pregnancy
Third Pregnancy Trimester
Vacuum
Cesarean Section
Multivariate Analysis
Parturition
Interviews

Keywords

  • birth trauma
  • forceps
  • Levator avulsion
  • pelvic organ prolapse
  • ultrasound
  • urogynecology

ASJC Scopus subject areas

  • Obstetrics and Gynaecology

Cite this

Caudwell-Hall, J., Kamisan @ Atan, I., Martin, A., Guzman Rojas, R., Langer, S., Shek, K., & Dietz, H. P. (2017). Intrapartum predictors of maternal levator ani injury. Acta Obstetricia et Gynecologica Scandinavica, 96(4), 426-431. https://doi.org/10.1111/aogs.13103

Intrapartum predictors of maternal levator ani injury. / Caudwell-Hall, Jessica; Kamisan @ Atan, Ixora; Martin, Andrew; Guzman Rojas, Rodrigo; Langer, Susanne; Shek, Kalai; Dietz, Hans P.

In: Acta Obstetricia et Gynecologica Scandinavica, Vol. 96, No. 4, 01.04.2017, p. 426-431.

Research output: Contribution to journalArticle

Caudwell-Hall, J, Kamisan @ Atan, I, Martin, A, Guzman Rojas, R, Langer, S, Shek, K & Dietz, HP 2017, 'Intrapartum predictors of maternal levator ani injury', Acta Obstetricia et Gynecologica Scandinavica, vol. 96, no. 4, pp. 426-431. https://doi.org/10.1111/aogs.13103
Caudwell-Hall, Jessica ; Kamisan @ Atan, Ixora ; Martin, Andrew ; Guzman Rojas, Rodrigo ; Langer, Susanne ; Shek, Kalai ; Dietz, Hans P. / Intrapartum predictors of maternal levator ani injury. In: Acta Obstetricia et Gynecologica Scandinavica. 2017 ; Vol. 96, No. 4. pp. 426-431.
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