Levator avulsion is associated with pelvic organ prolapse 23 years after the first childbirth

ProLong Study Group

Research output: Contribution to journalArticle

Abstract

Objectives—This study aimed to ascertain the association between levator avulsion and pelvic organ prolapse (POP). Methods—This was a cross-sectional study involving 195 women enrolled in a longitudinal cohort study and seen 20 years after an index birth. All had a standardized patient-administered questionnaire, the International Continence Society Pelvic Organ Prolapse Quantification assessment and 4D translabial ultrasound. Main outcome measures were objective POP clinically and on translabial ultrasound. Postimaging assessment of levator integrity and sonographically determined pelvic organ descent was done blinded against other data. Results—Of 195 women who were seen a mean of 23 (range, 19.4–46.2) years after their first birth, one declined ultrasound assessment and was excluded, leaving 194. Mean age was 50.2 (range 36.9–66.5) years with a mean body mass index (BMI) of 27.6 (range, 18.3–54.3) kg/m 2 . Median parity was 3 (range 1–14). Ninety-one percent (n = 176) had delivered vaginally. Eighteen percent (n = 34) were symptomatic of prolapse. Clinically, 36% (n = 69) had significant POP. Levator avulsion was diagnosed in 16% (n = 31). Mean levator avulsion defect score was 2.2 (range, 0–12). On univariate analysis, levator avulsion and levator avulsion defect score were associated with clinically and sonographically significant POP, that is, odds ratio 2.6 (1.2–5.7), P =.01; and odds ratio 3.3 (1.4–7.7); P =.003, respectively; Ba (P<.001); bladder (P<.001); uterine (P<.001) and rectal ampulla (P =.009) descent, but not POP symptoms, C, and Bp. Multivariate analysis controlling for potential confounders confirmed our findings. Conclusions—Levator avulsion is associated with female pelvic organ prolapse, especially of the anterior and central compartments. This association may become stronger with aging.

Original languageEnglish
Pages (from-to)2829-2838
Number of pages10
JournalJournal of Ultrasound in Medicine
Volume37
Issue number12
DOIs
Publication statusPublished - 1 Jan 2018

Fingerprint

Pelvic Organ Prolapse
Parturition
Odds Ratio
Birth Order
Prolapse
Parity
Longitudinal Studies
Urinary Bladder
Body Mass Index
Cohort Studies
Multivariate Analysis
Cross-Sectional Studies
Outcome Assessment (Health Care)

Keywords

  • Levator avulsion
  • Pelvic floor ultrasound
  • Pelvic organ prolapse
  • Translabial ultrasound

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology
  • Radiology Nuclear Medicine and imaging

Cite this

Levator avulsion is associated with pelvic organ prolapse 23 years after the first childbirth. / ProLong Study Group.

In: Journal of Ultrasound in Medicine, Vol. 37, No. 12, 01.01.2018, p. 2829-2838.

Research output: Contribution to journalArticle

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abstract = "Objectives—This study aimed to ascertain the association between levator avulsion and pelvic organ prolapse (POP). Methods—This was a cross-sectional study involving 195 women enrolled in a longitudinal cohort study and seen 20 years after an index birth. All had a standardized patient-administered questionnaire, the International Continence Society Pelvic Organ Prolapse Quantification assessment and 4D translabial ultrasound. Main outcome measures were objective POP clinically and on translabial ultrasound. Postimaging assessment of levator integrity and sonographically determined pelvic organ descent was done blinded against other data. Results—Of 195 women who were seen a mean of 23 (range, 19.4–46.2) years after their first birth, one declined ultrasound assessment and was excluded, leaving 194. Mean age was 50.2 (range 36.9–66.5) years with a mean body mass index (BMI) of 27.6 (range, 18.3–54.3) kg/m 2 . Median parity was 3 (range 1–14). Ninety-one percent (n = 176) had delivered vaginally. Eighteen percent (n = 34) were symptomatic of prolapse. Clinically, 36{\%} (n = 69) had significant POP. Levator avulsion was diagnosed in 16{\%} (n = 31). Mean levator avulsion defect score was 2.2 (range, 0–12). On univariate analysis, levator avulsion and levator avulsion defect score were associated with clinically and sonographically significant POP, that is, odds ratio 2.6 (1.2–5.7), P =.01; and odds ratio 3.3 (1.4–7.7); P =.003, respectively; Ba (P<.001); bladder (P<.001); uterine (P<.001) and rectal ampulla (P =.009) descent, but not POP symptoms, C, and Bp. Multivariate analysis controlling for potential confounders confirmed our findings. Conclusions—Levator avulsion is associated with female pelvic organ prolapse, especially of the anterior and central compartments. This association may become stronger with aging.",
keywords = "Levator avulsion, Pelvic floor ultrasound, Pelvic organ prolapse, Translabial ultrasound",
author = "{ProLong Study Group} and {Kamisan @ Atan}, Ixora and Sylvia Lin and Dietz, {Hans Peter} and Peter Herbison and Wilson, {Peter D.}",
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T1 - Levator avulsion is associated with pelvic organ prolapse 23 years after the first childbirth

AU - ProLong Study Group

AU - Kamisan @ Atan, Ixora

AU - Lin, Sylvia

AU - Dietz, Hans Peter

AU - Herbison, Peter

AU - Wilson, Peter D.

PY - 2018/1/1

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N2 - Objectives—This study aimed to ascertain the association between levator avulsion and pelvic organ prolapse (POP). Methods—This was a cross-sectional study involving 195 women enrolled in a longitudinal cohort study and seen 20 years after an index birth. All had a standardized patient-administered questionnaire, the International Continence Society Pelvic Organ Prolapse Quantification assessment and 4D translabial ultrasound. Main outcome measures were objective POP clinically and on translabial ultrasound. Postimaging assessment of levator integrity and sonographically determined pelvic organ descent was done blinded against other data. Results—Of 195 women who were seen a mean of 23 (range, 19.4–46.2) years after their first birth, one declined ultrasound assessment and was excluded, leaving 194. Mean age was 50.2 (range 36.9–66.5) years with a mean body mass index (BMI) of 27.6 (range, 18.3–54.3) kg/m 2 . Median parity was 3 (range 1–14). Ninety-one percent (n = 176) had delivered vaginally. Eighteen percent (n = 34) were symptomatic of prolapse. Clinically, 36% (n = 69) had significant POP. Levator avulsion was diagnosed in 16% (n = 31). Mean levator avulsion defect score was 2.2 (range, 0–12). On univariate analysis, levator avulsion and levator avulsion defect score were associated with clinically and sonographically significant POP, that is, odds ratio 2.6 (1.2–5.7), P =.01; and odds ratio 3.3 (1.4–7.7); P =.003, respectively; Ba (P<.001); bladder (P<.001); uterine (P<.001) and rectal ampulla (P =.009) descent, but not POP symptoms, C, and Bp. Multivariate analysis controlling for potential confounders confirmed our findings. Conclusions—Levator avulsion is associated with female pelvic organ prolapse, especially of the anterior and central compartments. This association may become stronger with aging.

AB - Objectives—This study aimed to ascertain the association between levator avulsion and pelvic organ prolapse (POP). Methods—This was a cross-sectional study involving 195 women enrolled in a longitudinal cohort study and seen 20 years after an index birth. All had a standardized patient-administered questionnaire, the International Continence Society Pelvic Organ Prolapse Quantification assessment and 4D translabial ultrasound. Main outcome measures were objective POP clinically and on translabial ultrasound. Postimaging assessment of levator integrity and sonographically determined pelvic organ descent was done blinded against other data. Results—Of 195 women who were seen a mean of 23 (range, 19.4–46.2) years after their first birth, one declined ultrasound assessment and was excluded, leaving 194. Mean age was 50.2 (range 36.9–66.5) years with a mean body mass index (BMI) of 27.6 (range, 18.3–54.3) kg/m 2 . Median parity was 3 (range 1–14). Ninety-one percent (n = 176) had delivered vaginally. Eighteen percent (n = 34) were symptomatic of prolapse. Clinically, 36% (n = 69) had significant POP. Levator avulsion was diagnosed in 16% (n = 31). Mean levator avulsion defect score was 2.2 (range, 0–12). On univariate analysis, levator avulsion and levator avulsion defect score were associated with clinically and sonographically significant POP, that is, odds ratio 2.6 (1.2–5.7), P =.01; and odds ratio 3.3 (1.4–7.7); P =.003, respectively; Ba (P<.001); bladder (P<.001); uterine (P<.001) and rectal ampulla (P =.009) descent, but not POP symptoms, C, and Bp. Multivariate analysis controlling for potential confounders confirmed our findings. Conclusions—Levator avulsion is associated with female pelvic organ prolapse, especially of the anterior and central compartments. This association may become stronger with aging.

KW - Levator avulsion

KW - Pelvic floor ultrasound

KW - Pelvic organ prolapse

KW - Translabial ultrasound

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