Abstract
Introduction and hypothesis
This study seeks to assess the effects of forceps-assisted delivery on the levator hiatus.
Methods
Seventy-six women were investigated 12 months after forceps-assisted delivery. Introital three-/four-dimensional ultrasound measured volumes at rest and during the Valsalva maneuver. Morphological parameters analyzed were angle gamma, hiatal area, pubovisceral angle, and continuity between the muscle and pelvic sidewall. Avulsion was diagnosed by loss of continuity.
Results
Forty-eight women had avulsion injuries, 23 had bilateral, and 25 had unilateral. Bilateral avulsion increased hiatal area during straining and at rest and was associated with changes in bladder neck position at rest. Unilateral avulsion injury was associated with a higher pubovisceral angle on the side of the avulsion.
Conclusion
Forceps-assisted vaginal delivery is associated with levator ani injury. Avulsion of the pubovisceral muscle seems more common after forceps delivery than after spontaneous vaginal delivery. Avulsion alters hiatal shape and area and influences the position and mobility of the anterior compartment.
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Acknowledgments
This study was supported by the Internal Grant Agency of the Ministry of Health of the Czech Republic, grant number NR 8353-3. We thank Associate Professor Karel Zvara MSc. Ph.D. for the important contribution to the data analysis and interpretation of results.
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Krofta, L., Otčenášek, M., Kašíková, E. et al. Pubococcygeus–puborectalis trauma after forceps delivery: evaluation of the levator ani muscle with 3D/4D ultrasound. Int Urogynecol J 20, 1175–1181 (2009). https://doi.org/10.1007/s00192-009-0837-6
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DOI: https://doi.org/10.1007/s00192-009-0837-6