Levator trauma after vaginal delivery.
OBJECTIVE
To date, the evidence on pelvic floor injury in labor remains sketchy due to a lack of prospective studies comparing pelvic floor imaging before and after childbirth. We intended to define the incidence of major trauma to the pubovisceral muscle.


METHODS
A total of 61 nulliparous women were seen at 36-40 weeks of gestation in a prospective observational study. The assessment included an interview and 3-dimensional translabial ultrasound and was repeated 2-6 months postpartum.


RESULTS
Fifty women (82%) were seen postpartum. Of the 39 women delivered vaginally, levator avulsion was diagnosed in 14 (36%, 95% confidence interval 21-51%). Among those delivered vaginally, there were associations with higher maternal age (P = .10), vaginal operative delivery (P = .07), and worsened stress incontinence postpartum (P = .02).


CONCLUSIONS
Avulsion of the inferomedial aspects of the levator ani from the pelvic sidewall occurred in approximately one third of all women delivered vaginally and was associated with stress incontinence 3 months after childbirth.
Dietz
Hans Peter
HP
Royal Prince Alfred Hospital, Sydney, and University of Sydney, Western Clinical School, Nepean Campus, Australia. hpdietz@bigpond.com
Lanzarone
Valeria
V
D000328:Adult; D036861:Delivery, Obstetric; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional; D036801:Parturition; D017773:Pelvic Floor / Q000000981:diagnostic imaging / Q000293:injuries* / Q000503:physiopathology; D049590:Postpartum Period; D011247:Pregnancy; D011446:Prospective Studies; D014463:Ultrasonography; D014550:Urinary Incontinence, Stress / Q000209:etiology