To evaluate the morphological outcome of levator ani muscle (LAM) avulsion 3-5 years after the first delivery and the effect of a second delivery on it. The impact of LAM avulsion on the pelvic floor disorders of women was also studied.
666 women who had been assessed for LAM avulsion 8 weeks after first delivery were invited for a follow-up. They were evaluated by Pelvic Floor Distress Inventory (PFDI), POP-Q examination and 3D translabial ultrasound.
399 women, 151 being multiparous, completed the study. The mean interval from their first delivery was 42.3 ± 7.6 months. Among those who had LAM avulsion at 8 weeks after their first delivery, 9 out of 69 (13%) had no LAM avulsion at this follow-up. One woman (0.9%) had a new LAM avulsion after her second vaginal delivery. More women in the LAM avulsion group reported stress urinary incontinence (SUI) (OR 2.09, 95% CI 1.18 - 3.70, P = 0.01), but not symptoms of prolapse. Women with LAM avulsion had higher PFDI UDI and POPDI scores compared with those without avulsion (UDI median (inter-quatile range) 17.7 (27.4) vs 9.2 (22.1), P = 0.045; and POPDI 20.8 (31.7) vs 10.7 (32.8), P = 0.021).
The risk of a new LAM avulsion after a second vaginal delivery was low (0.9%). Healing of LAM avulsion was observed in 13% of women who had one or more deliveries. By 3-5years follow-up, statistically more women with LAM avulsion reported SUI. Women with LAM avulsion had a higher PFDI UDI and POPDI scores, implying that they had more bothersome symptoms.
Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2016 Jul 01 [Epub ahead of print]
Symphorosa S C Chan, Rachel Y K Cheung, L L Lee, K W Choy, Tony K H Chung
Department of Obstetrics & Gynaecology, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong., Department of Obstetrics & Gynaecology, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong., Department of Obstetrics & Gynaecology, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong., Department of Obstetrics & Gynaecology, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong., Department of Obstetrics & Gynaecology, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong.