title: Vacuum-assisted vaginal delivery and levator ani avulsion in primiparous women.
abstract: OBJECTIVE
  We compared the incidence and type of levator ani avulsion diagnosed by translabial ultrasound evaluation in primiparous women six months after vacuum-assisted or spontaneous vaginal delivery.
  
  
  METHODS
  This retrospective observational study was performed between January 2011 and December 2013. Primiparous women six months after vacuum-assisted vaginal delivery and after spontaneous vaginal delivery underwent translabial ultrasound evaluation. The distance between the urethra and fibers of the musculus levator ani puborectalis (levator-urethra gap) was measured. A levator-urethra gap >25 mm was considered a musculus levator ani avulsion.
  
  
  RESULTS
  In total, 184 women participated in the study. Among them, 92 had vacuum extraction and 92 had uncomplicated spontaneous delivery. A longer levator-urethra gap on both sides of the pubic bone was found in women after vacuum-assisted vaginal delivery (p < 0.0001 for both sides). Musculus levator ani avulsion was identified in 20 women (unilateral in 16 cases and bilateral in four cases). No difference in an incidence of musculus levator ani avulsion was identified in women after vacuum-assisted vaginal delivery [11/92 (12%)] compared to spontaneous delivery [9/92 (10%); p = 0.81].
  
  
  CONCLUSIONS
  Vacuum-assisted vaginal delivery in primiparous women is associated with a longer levator-urethra gap but not with a higher frequency of avulsion of the musculus levator ani.
authors.affiliation: a Department of Gynecology and Obstetrics , University Hospital Ostrava , Ostrava , Czech Republic .|b Department of Surgical Studies , Faculty of Medicine, Ostrava University , Ostrava , Czech Republic .
authors.forename: Igor
authors.initials: I
authors.lastname: Michalec
authors.affiliation: a Department of Gynecology and Obstetrics , University Hospital Ostrava , Ostrava , Czech Republic .|b Department of Surgical Studies , Faculty of Medicine, Ostrava University , Ostrava , Czech Republic .
authors.forename: Ondrej
authors.initials: O
authors.lastname: Simetka
authors.affiliation: a Department of Gynecology and Obstetrics , University Hospital Ostrava , Ostrava , Czech Republic .
authors.forename: Marie
authors.initials: M
authors.lastname: Navratilova
authors.affiliation: a Department of Gynecology and Obstetrics , University Hospital Ostrava , Ostrava , Czech Republic .
authors.forename: Michaela
authors.initials: M
authors.lastname: Tomanova
authors.affiliation: a Department of Gynecology and Obstetrics , University Hospital Ostrava , Ostrava , Czech Republic .
authors.forename: Marcel
authors.initials: M
authors.lastname: Gartner
authors.affiliation: c Department of Mathematical Methods in Economics , Faculty of Economics, Technical University of Ostrava , Ostrava , Czech Republic .
authors.forename: Dana
authors.initials: D
authors.lastname: Salounova
authors.affiliation: d Department of Gynecology and Obstetrics , Faculty of Medicine, Palacky University in Olomouc and University Hospital Olomouc , Olomouc , Czech Republic , and.
authors.forename: Martin
authors.initials: M
authors.lastname: Prochazka
authors.affiliation: e Department of Gynecology and Obstetrics , University Hospital Hradec Kralove , Hradec Kralove , Czech Republic.
authors.forename: Marian
authors.initials: M
authors.lastname: Kacerovsky
mesh_terms: D000328:Adult; D015992:Body Mass Index; D036861:Delivery, Obstetric; D004841:Episiotomy; D005260:Female; D006801:Humans; D010298:Parity; D017773:Pelvic Floor / Q000293:injuries*; D059952:Pelvic Floor Disorders / Q000453:epidemiology; D011247:Pregnancy; D012189:Retrospective Studies; D014463:Ultrasonography; D014521:Urethra; D014620:Vacuum Extraction, Obstetrical / Q000009:adverse effects*
keywords: Delivery; pelvic floor; vacuum extraction