The effect of levator avulsion on hiatal dimension and function

被引:113
作者
Abdool, Zeelha [2 ]
Shek, Ka Lai [1 ]
Dietz, Hans Peter [1 ]
机构
[1] Univ Sydney, Nepean Clin Sch, Dept Obstet & Gynecol, Penrith, NSW 2750, Australia
[2] Pretoria Acad Hosp, Dept Obstet & Gynecol, Pretoria, South Africa
关键词
levator avulsion; pelvic floor muscle; prolapse; puborectalis muscle; 3-dimensional ultrasound; PELVIC FLOOR; ANI MUSCLE; ABNORMALITIES; TRAUMA;
D O I
10.1016/j.ajog.2009.02.005
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
OBJECTIVE: Pelvic floor trauma as a result of vaginal childbirth can cause significant pelvic floor morbidity. In this observational study, we intended to define whether such trauma is associated with abnormal hiatal biometry and/or abnormal biomechanical properties of the levator muscle. STUDY DESIGN: The datasets of 414 urogynecologic patients were assessed in a retrospective study. Patients underwent an interview, clinical examination, and 3-/4-dimensional pelvic floor ultrasound. All analysis was performed offline using proprietary software. Hiatal dimensions and strain were measured. RESULTS: In 21.1% of parous women with a history of vaginal delivery, an avulsion of the levator muscle was diagnosed, and in 8.6% it was bilateral. The relative risk of abnormal distensibility was 3.5 (95% confidence interval, 1.7-6.5) in unilateral and 3.96 (95% confidence interval, 1.7-9.2) in bilateral avulsion. Avulsion increased muscle distensibility on Valsalva and reduced muscle shortening on pelvic floor muscle contraction. CONCLUSION: Avulsion injury is associated with abnormal levator biometry and function.
引用
收藏
页码:89.e1 / 89.e5
页数:5
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