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Am J Obstet Gynecol. 2010 Jun;202(6):586.e1-6. doi: 10.1016/j.ajog.2009.11.038. Epub 2010 Jan 15.

Can levator avulsion be predicted antenatally?

Author information

1
Department of Obstetrics and Gynecology, Nepean Clinical School, University of Sydney, Nepean Hospital, Sydney, New South Wales, Australia. shekkalai@yahoo.com.hk

Abstract

OBJECTIVE:

We sought to determine whether antepartum prediction of major levator trauma is feasible.

STUDY DESIGN:

A prospective longitudinal study was undertaken on 488 pregnant nulliparous women seen between 36-38 weeks and again 4 months after delivery. All underwent an interview and 4-dimensional transperineal ultrasound. Diagnosis of levator trauma (avulsion) on tomographic ultrasound was correlated with predelivery demographic variables and ultrasound parameters.

RESULTS:

In all, 367 women returned for postpartum assessment after normal vaginal delivery (n = 187), vacuum/forceps (n = 54), and cesarean section (n = 126). Avulsion was diagnosed in 34 vaginally parous women (14%). Maternal age, family history of cesarean section, hiatal dimensions, levator muscle strain, bladder neck descent, and subpubic arch angle were not associated with avulsion. The only predictor identified was a lower body mass index (P = .005).

CONCLUSION:

Antepartum prediction of major levator trauma may be difficult or impossible. Future studies should focus on modification of current obstetric practices and antepartum interventions applicable to the general population.

PMID:
20079479
DOI:
10.1016/j.ajog.2009.11.038
[Indexed for MEDLINE]

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