title: Prevalence of levator ani muscle injury in Chinese women after first delivery.
abstract: OBJECTIVE
  To assess the prevalence of levator ani muscle injury in Chinese women after their first delivery and investigate associated factors.
  
  
  METHODS
  A prospective observational study was conducted involving Chinese nulliparous women recruited in the first trimester of pregnancy. Translabial ultrasound was performed at 35-38 weeks' gestation and 8 weeks postpartum and three-dimensional volume datasets were obtained. Offline analysis to detect levator ani muscle injury was performed by investigators blinded to the delivery details.
  
  
  RESULTS
  339 women, with a mean age of 30.6 ± 3.9 years, completed the study. Overall, 201 (59.3%) had a spontaneous vaginal delivery, 62 (18.3%) an operative vaginal delivery (48 ventouse extraction and 14 forceps delivery), 14 (4.1%) an elective Cesarean section and 62 (18.3%) an emergency Cesarean section. No levator ani muscle injury was detected in any woman antenatally. After vaginal delivery, 57 (21.7% (95% CI, 16.7-26.7%)) women had levator ani muscle injury. The rates of injury for spontaneous vaginal delivery, ventouse extraction and forceps delivery were 15.4%, 33.3% and 71.4%, respectively. There was no levator ani muscle injury in the Cesarean section groups. Logistic regression analysis showed that only operative vaginal delivery (odds ratio, 3.09) was associated with an independent increase in the likelihood of levator ani muscle injury. Intrapartum epidural analgesics, duration of second stage of labor and infant birth weight were not independently associated with levator ani muscle injury.
  
  
  CONCLUSIONS
  The prevalence of levator ani muscle injury in Chinese women after their first vaginal delivery was 21.7% (95% CI, 16.7-26.7%). Operative vaginal delivery was found to increase the likelihood of women suffering such injury. A longer follow-up of these women and future studies on the effects of episiotomy are proposed.
authors: Department of Obstetrics & Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong. symphorosa@cuhk.edu.hk
authors: S S C
authors: SS
authors: Chan
authors: R Y K
authors: RY
authors: Cheung
authors: A K W
authors: AK
authors: Yiu
authors: L L L
authors: LL
authors: Lee
authors: A W L
authors: AW
authors: Pang
authors: K W
authors: KW
authors: Choy
authors: T Y
authors: TY
authors: Leung
authors: T K H
authors: TK
authors: Chung
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000000981:diagnostic imaging* / Q000293:injuries* / Q000503:physiopathology; D044466:Asian People; D015992:Body Mass Index; D002585:Cesarean Section; D036861:Delivery, Obstetric / Q000009:adverse effects*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D010298:Parity; D017773:Pelvic Floor / Q000000981:diagnostic imaging* / Q000293:injuries* / Q000503:physiopathology; D049590:Postpartum Period; D011247:Pregnancy; D015995:Prevalence; D011446:Prospective Studies; D014463:Ultrasonography