Fetal head circumference and length of second stage of labor are risk factors for levator ani muscle injury, diagnosed by 3-dimensional transperineal ultrasound in primiparous women

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• 作者：Dan V. Valsky ; Michal Lipschuetz ; Angelika Bord ; Ido Eldar ; Baruch Messing ; Drorith Hochner-Celnikier ; Yuval Lavy ; Sarah M. Cohen ; Simcha Yagel
• 关键词：levator ani muscle trauma ; 3-dimensional transperineal ultrasound ; vaginal delivery
• 刊名：American Journal of Obstetrics and Gynecology
• 出版年：2009
• 出版时间：July 2009
• 年：2009
• 卷：201
• 期：1
• 页码：91.e1-91.e7
• 全文大小：1548 K

文摘

Objective

We evaluated rate of levator ani muscle (LAM) avulsion among primiparae using 3-dimensional transperineal ultrasound to identify possible risk factors for such trauma.

Study Design

We conducted a prospective observational study. Three-dimensional transperineal ultrasound was performed on all subjects. Primiparae were evaluated 24-72 hours after vaginal delivery. In all, 32 nulliparous gravidae (35-41 weeks) and 15 elective cesarean delivery primiparae were evaluated as methodological controls. We compared newborn head circumference (HC), birthweight, second stage duration, maternal age, baby sex, episiotomy, and instrumental delivery.

Results

LAM trauma was observed in 39 of 210 (18.8 % ) patients and no controls. Odds ratio for LAM trauma when newborn HC ≥ 35.5 cm was 3.343 (95 % confidence interval, 1.33-8.42); when second stage duration ≥ 110 minutes, odds ratio was 2.27 (95 % confidence interval, 1.07-4.81). Logistic regression showed that HC ≥ 35.5 and second stage duration ≥ 110 minutes increased odds of LAM trauma by a factor of 5.32.

Conclusion

Large HC and prolonged second stage duration are risk factors in LAM trauma. Elective cesarean delivery may prevent LAM trauma.