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16.01.2019 | Original Article

Delivery mode and the risk of levator muscle avulsion: a meta-analysis

verfasst von: Talia Friedman, Guy D. Eslick, Hans Peter Dietz

Erschienen in: International Urogynecology Journal

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Abstract

Introduction and hypothesis

Female pelvic organ prolapse (POP) is a common condition, with a lifetime risk for surgery of 10–20%. Pregnancy and childbirth are the commonest modifiable risk factors for POP, and avulsion of the levator ani muscle is likely to be an etiological factor. Avulsion is more common in instrumental delivery. However, we were unable to identify a meta-analysis on this issue. Our aim was to perform a systemic review and quantitative meta-analysis of the prevalence of avulsion relative to delivery mode.

Methods

Four electronic databases (MEDLINE, PubMed, Embase, and Google Scholar) were searched for studies published between 1991 and 1 October 2018 without language restrictions.

Results

Twenty studies met inclusion criteria, and 14 were prospective. Seventeen used sonographic techniques; three were magnetic resonance (MR) studies. For this review, three comparisons were performed: forceps vs. vacuum (9 studies), forceps vs. normal vaginal delivery (NVD) (12 studies), and vacuum vs. NVD (12 studies). The first meta-analysis showed an increased risk for avulsion following forceps compared with vacuum, with an odds ratio (OR) of 4.57 and confidence interval (CI) 3.21–6.51, p < 0.001. The second showed an increased risk for avulsion following forceps compared with NVD, with an OR of 6.94 (4.93–9.78), p < 0.001. The third showed no significant increased risk for avulsion following vacuum compared with NVD, with an OR of 1.31 (1.00–1.72), p = 0.051.

Conclusions

Forceps is a strong risk factor for avulsion, with an OR of 6.94 (4.93–9.78) compared with NVD and an OR of 4.57 (3.21–6.51) compared with vacuum birth.

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Titel: Delivery mode and the risk of levator muscle avulsion: a meta-analysis
verfasst von: Talia Friedman
Guy D. Eslick
Hans Peter Dietz
Publikationsdatum: 16.01.2019
Verlag: Springer International Publishing
Erschienen in: International Urogynecology Journal
Print ISSN: 0937-3462
Elektronische ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-018-3827-8

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Springer Medizin

Delivery mode and the risk of levator muscle avulsion: a meta-analysis

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

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Springer Medizin

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

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Neu im Fachgebiet Gynäkologie und Geburtshilfe

Hirsutismus bei PCOS: Laser- und Lichttherapien helfen

ICI-Therapie in der Schwangerschaft wird gut toleriert

Weniger postpartale Depressionen nach Esketamin-Einmalgabe

Bei RSV-Impfung vor 60. Lebensjahr über Off-Label-Gebrauch aufklären!

Update Gynäkologie