title: Does episiotomy protect against injury of the levator ani muscle in normal vaginal delivery?
abstract: OBJECTIVE
  To investigate whether episiotomy is associated with avulsion of the levator ani in its pubic insertion after normal vaginal delivery.
  
  
  METHODS
  This is an observational study at a tertiary obstetric unit recruited 194 primiparous women who had normal vaginal delivery with or without episiotomy. All women underwent translabial 4D ultrasound scanning after delivery. Tomographic ultrasound imaging was used to diagnose levator avulsion. Lesions were recorded as unilateral or bilateral. The investigators were blinded to all clinical data. The influence of other variables associated with delivery such as maternal age, body mass index, gestational age, birth weight, fetal head circumference, and use of epidural anesthesia was recorded and their relation with avulsion was also studied.
  
  
  RESULTS
  Avulsion was identified in eleven (10.9%) of the 101 women with episiotomy and in fourteen (15.1%) of the 93 women without. The difference was not statistically significant (P = 0.401). Other variables showed no influence on the prevalence of avulsion.
  
  
  CONCLUSIONS
  Episiotomy does not appear to be associated with injury to the levator ani muscle in its pubic insertion in normal vaginal delivery.
authors.affiliation: Obstetrics and Gynecology, University Hospital Mutua Terrassa, Terrassa, Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Cassadó
authors.forename: Antoni
authors.initials: A
authors.lastname: Pessarrodona
authors.forename: Monica
authors.initials: M
authors.lastname: Rodriguez-Carballeira
authors.forename: Lourdes
authors.initials: L
authors.lastname: Hinojosa
authors.forename: Gemma
authors.initials: G
authors.lastname: Manrique
authors.forename: Adriana
authors.initials: A
authors.lastname: Márquez
authors.forename: Marina
authors.initials: M
authors.lastname: Macias
mesh_terms: D000293:Adolescent; D000328:Adult; D036861:Delivery, Obstetric; D004841:Episiotomy; D005260:Female; D006801:Humans; D007744:Obstetric Labor Complications / Q000000981:diagnostic imaging / Q000517:prevention & control*; D017773:Pelvic Floor / Q000000981:diagnostic imaging / Q000293:injuries*; D011247:Pregnancy; D014463:Ultrasonography; D055815:Young Adult
keywords: avulsion; delivery; episiotomy; levator ani; pelvic floor; ultrasound