Type of levator ani muscle avulsion as predictor for the disappearance of avulsion

• Published in: Neurourology and urodynamics Vol. 39; no. 8; pp. 2293 - 2300
• Main Authors: García‐Mejido, José Antonio, Sainz, José Antonio
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01-11-2020
• Subjects: 3D transperineal ultrasound; Adult; avulsion; Contraction; delivery; Delivery, Obstetric - adverse effects; Female; Humans; levator ani muscle; Pelvic Floor - diagnostic imaging; Pelvic Floor - injuries; Postpartum; Postpartum Period; Pregnancy; Prospective Studies; Ultrasonic imaging; Ultrasonography; Ultrasound; Vagina; avulsion; delivery; 3D transperineal ultrasound; levator ani muscle
• ISSN: 0733-2467; 1520-6777
• DOI: 10.1002/nau.24484

Objectives
The objective of our study was to establish whether the type of levator ani muscle (LAM) avulsion diagnosed 6 months after delivery influences the integrity of the LAM at 1 year after delivery and determine its influence on the levator hiatus area.
Study Design
This observational prospective cohort study included 192 primiparous women with vaginal delivery. Transperineal ultrasound examinations were performed at 6 months and 1 year postpartum. Levator hiatus measurements (anteroposterior diameter, transverse diameter, and area) were performed in the plane of minimal dimensions. Complete avulsion was defined based on maximum contraction in multislice mode. Type I LAM avulsion was present when most lateral fibers of the pubovisceral muscle were observed at its insertion at the pubic level (the arch of the elevator remained intact). Type II LAM avulsion was defined as a complete detachment of the pubovisceral muscle from its insertion at the pubic level.
Results
In total, 192 patients were recruited after delivery; 48 patients were diagnosed with complete LAM avulsion, and 13 patients with avulsion did not attend the second ultrasound follow‐up at 1 year after delivery. Thirty‐five patients with complete LAM avulsion were included in the study. At 6 months after delivery, 51 LAM avulsions were observed in 35 patients (including bilateral LAM avulsion in 16 cases), of which 54.9% were right avulsions and 45.1% left avulsions. Furthermore, 11 (five right and six left) were type I LAM avulsions at the 6‐month assessment, and all of these had disappeared 1 year after delivery. However, none of the type II LAM avulsions (23 right and 17 left) observed at 6 months had disappeared at the second ultrasound examination. There were no differences between the LAM areas detected at the first and second ultrasound examinations (10.2 ± 3.3 vs 9.3 ± 1.8; P = .404).
Conclusions
The type of LAM avulsion observed at 6 months after childbirth predicts LAM persistence at 1 year postpartum.