It is the first birth that does the damage: a cross-sectional study 20 years after delivery

for the ProLong Study Group

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Introduction and hypothesis: Levator ani muscle (LAM) and anal sphincter tears are common after vaginal birth and are associated with female pelvic organ prolapse and anal incontinence. The impact of subsequent births on LAM and external anal sphincter (EAS) integrity is less well defined. The objective of this study was to determine the prevalence of LAM and EAS trauma in primiparous (VP1) and multiparous (VP2+) women who had delivered vaginally to assess if there were differences between the two groups. The null hypothesis was: there is no significant difference in the prevalence of LAM and EAS trauma between the two groups. Methods: This was a cross-sectional study involving 195 women, participants of the Dunedin arm of the ProLong study (PROlapse and incontinence LONG-term research study) seen 20 years after their index birth. Assessment included a standardized questionnaire, ICS POP-Q and 4D translabial ultrasound. Post-imaging analysis of LAM and EAS integrity was undertaken blinded against other data. Statistical analysis was performed using Fisher’s exact test and results were expressed as odds ratios (OR). Results: LAM avulsion and EAS defects were diagnosed in 31 (16%) and 24 (12.4%) women respectively. No significant difference in the prevalence of levator avulsion and EAS defects between primiparous (VP1) and multiparous (VP2+) women who had delivered vaginally (OR 1.9, 95% CI 0.72–5.01, p = 0.26) and (OR 1.2, 95% CI 0.4–3.8, p = 0.76) respectively. Conclusions: Most LAM avulsions and EAS defects seem to be caused by the first vaginal birth. Subsequent vaginal deliveries after the first were unlikely to cause further LAM trauma.

Original languageEnglish
Pages (from-to)1-7
Number of pages7
JournalInternational Urogynecology Journal
DOIs
Publication statusAccepted/In press - 21 Mar 2018

Fingerprint

Birth Order
Anal Canal
Cross-Sectional Studies
Muscles
Odds Ratio
Parturition
Wounds and Injuries
Pelvic Organ Prolapse
Prolapse

Keywords

  • Anal sphincter tears
  • Levator ani avulsion
  • Pelvic floor trauma
  • Pelvic organ prolapse
  • Vaginal parity

ASJC Scopus subject areas

  • Obstetrics and Gynaecology
  • Urology

Cite this

It is the first birth that does the damage : a cross-sectional study 20 years after delivery. / for the ProLong Study Group.

In: International Urogynecology Journal, 21.03.2018, p. 1-7.

Research output: Contribution to journalArticle

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abstract = "Introduction and hypothesis: Levator ani muscle (LAM) and anal sphincter tears are common after vaginal birth and are associated with female pelvic organ prolapse and anal incontinence. The impact of subsequent births on LAM and external anal sphincter (EAS) integrity is less well defined. The objective of this study was to determine the prevalence of LAM and EAS trauma in primiparous (VP1) and multiparous (VP2+) women who had delivered vaginally to assess if there were differences between the two groups. The null hypothesis was: there is no significant difference in the prevalence of LAM and EAS trauma between the two groups. Methods: This was a cross-sectional study involving 195 women, participants of the Dunedin arm of the ProLong study (PROlapse and incontinence LONG-term research study) seen 20 years after their index birth. Assessment included a standardized questionnaire, ICS POP-Q and 4D translabial ultrasound. Post-imaging analysis of LAM and EAS integrity was undertaken blinded against other data. Statistical analysis was performed using Fisher’s exact test and results were expressed as odds ratios (OR). Results: LAM avulsion and EAS defects were diagnosed in 31 (16{\%}) and 24 (12.4{\%}) women respectively. No significant difference in the prevalence of levator avulsion and EAS defects between primiparous (VP1) and multiparous (VP2+) women who had delivered vaginally (OR 1.9, 95{\%} CI 0.72–5.01, p = 0.26) and (OR 1.2, 95{\%} CI 0.4–3.8, p = 0.76) respectively. Conclusions: Most LAM avulsions and EAS defects seem to be caused by the first vaginal birth. Subsequent vaginal deliveries after the first were unlikely to cause further LAM trauma.",
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