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Prevalence of levator ani avulsion in a multicenter study (PAMELA study)

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Abstract

Purpose

The objective is to determine the prevalence of levator ani muscle (LAM) avulsion using four-dimensional ultrasound in primiparous women after vaginal delivery and according to delivery mode.

Methods

This prospective, multicenter study included 322 women evaluated at 6–12 months postpartum by four-dimensional transperineal ultrasound to identify levator ani muscle avulsion. The researcher who performed the ultrasound was blinded to all clinical data. Meaningful data about the birth were also recorded: mode of delivery, mother’s age and body mass index, duration of second stage, episiotomy, perineal tearing, anesthesia, assistant, head circumference and fetal weight.

Results

303 volumes were valid for evaluation. The overall prevalence of levator ani muscle avulsion was 18.8% (95% CI 14.4–23.2%). In our multivariate analysis, only mode of delivery reached statistical significance as a risk factor for levator ani muscle avulsion (p < 0.001). The prevalence according to the different modes of delivery was 7.8% in spontaneous delivery, 28.8% in vacuum-assisted and 51.1% in forceps-assisted delivery. Compared with spontaneous delivery, the OR for LAM avulsion was 12.31 with forceps (CI 95% 5.65–26.80) and 4.78 with vacuum-assisted delivery (CI 95% 2.15–10.63).

Conclusions

Levator ani avulsion during vaginal delivery in primiparous women occurs in nearly one in every five deliveries. Delivery mode is a significant and modifiable intrapartum risk factor for this lesion. The incidence is lower in spontaneous delivery and significantly increases when an instrument is used to assist delivery, especially forceps.

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Author information

Authors and Affiliations

  1. Obstetrics and Gynecology Department, Hospital Universitari Mútua de Terrassa, Plaça Dr. Robert, 4, 08221, Terrassa, Spain

    Jordi Cassadó & Eva Huguet

  2. Obstetrics and Gynecology Department, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain

    Marta Simó & Oriol Porta

  3. Obstetrics and Gynecology Department, Hospital Universitari de la Vall d’Hebrón, Barcelona, Spain

    Nuria Rodríguez

  4. Obstetrics and Gynecology Department, Consorci Sanitari d’Igualada, Igualada, Spain

    Irene Mora

  5. Obstetrics and Gynecology Department, Hospital General de Granollers, Granollers, Spain

    Marta Girvent

  6. Obstetrics and Gynecology Department, Hospital Universitari Dexeus, Barcelona, Spain

    Rebeca Fernández

  7. Sant Pau Biomedical Research Institute (IIB Sant Pau) and CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain

    Ignasi Gich

Authors
  1. Jordi Cassadó
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  2. Marta Simó
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  3. Nuria Rodríguez
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  5. Eva Huguet
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  8. Rebeca Fernández
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  9. Ignasi Gich
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Contributions

JC and MS project development, data collection, manuscript writing and editing. NR, OP, EH, IM, MG and RF data collection. IG statistical analysis.

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Correspondence to Jordi Cassadó.

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Cassadó, J., Simó, M., Rodríguez, N. et al. Prevalence of levator ani avulsion in a multicenter study (PAMELA study). Arch Gynecol Obstet 302, 273–280 (2020). https://doi.org/10.1007/s00404-020-05585-4

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  • DOI: https://doi.org/10.1007/s00404-020-05585-4

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