Neuropathic injury to the levator ani occurs in 1 in 4 primiparous women.
OBJECTIVE
We measured levator ani neuromuscular function before and after first delivery to identify the location, timing, and mechanism of injury.


METHODS
Fifty-eight primiparous women underwent electromyographic examination of the levator ani antepartum at 6 weeks and 6 months after the delivery. Antepartum turns/amplitude data were pooled to create a normal range. We calculated each woman's percentage of outliers from this range and assessed relationships between delivery and extent of injury.


RESULTS
At 6 weeks, 14 of 58 women (24.1%) had neuropathy, with 9 of those 14 women recovering by 6 months. At 6 months, 17 of 58 women (29.3%) were neuropathic, which included 12 new injuries. Women who had elective cesarean delivery had virtually no injury, but all other modes of delivery had similar injury rates.


CONCLUSIONS
Obstetric delivery is associated frequently with electromyographic evidence of neuropathic injury to the levator ani. The entire levator complex is at risk, and cesarean delivery while in labor is not protective.
Weidner
A C
AC
Division of Urogynecology, Duke University Medical Center, Durham, NC, USA.
Jamison
M G
MG
Branham
V
V
South
M M
MM
Borawski
K M
KM
Romero
A A
AA
D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects; D036861:Delivery, Obstetric / Q000009:adverse effects* / Q000706:statistics & numerical data; D004576:Electromyography; D005260:Female; D006801:Humans; D015994:Incidence; D007743:Labor, Obstetric; D009469:Neuromuscular Junction / Q000293:injuries*; D010298:Parity; D017773:Pelvic Floor / Q000294:innervation*; D011247:Pregnancy; D020127:Recovery of Function; D013997:Time Factors; D014947:Wounds and Injuries / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology