E-Posters-Intrapartum Risk Factors for Levator Ani Muscle Avulsion

Intrapartum Risk Factors for Levator Ani Muscle Avulsion - Ka Woon Wong, MBBS, MRCOG

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In this study, the researchers aimed to identify the intrapartum risk factors for levator ani muscle (LAM) avulsion, which is a risk factor for pelvic organ prolapse (POP). They conducted a prospective study on women undergoing their first vaginal delivery. The women were followed up and evaluated for LAM avulsion using three dimensional transperineal ultrasound (3D TPUS). <br /><br />Out of the 274 women who participated in the study, 195 returned for follow up. Among these women, 25% had LAM avulsion after vaginal birth. The use of forceps delivery and mediolateral episiotomy were identified as risk factors for LAM avulsion. The incidence of LAM avulsion was significantly higher after forceps delivery compared to ventouse delivery. Women were seven times more likely to sustain LAM avulsion following forceps delivery compared to ventouse delivery. Medioloateral episiotomy was also found to be associated with a higher risk of LAM avulsion. <br /><br />Multivariate analysis revealed that forceps delivery was the only independent risk factor for LAM avulsion. The study suggests that training should focus on minimizing the use of forceps when an assisted vaginal delivery is needed. Skills in ventouse cup selection and placement should be enhanced to reduce failure and avoid the need for a second instrument.<br /><br />In conclusion, the study found that forceps delivery is a significant risk factor for LAM avulsion. Identifying and minimizing this risk during childbirth can help reduce the occurrence of POP.

Keywords

intrapartum risk factors

levator ani muscle avulsion

pelvic organ prolapse

prospective study

vaginal delivery

three dimensional transperineal ultrasound

forceps delivery

mediolateral episiotomy

ventouse delivery

multivariate analysis