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Erschienen in: International Urogynecology Journal 11/2018

21.03.2018 | Original Article

It is the first birth that does the damage: a cross-sectional study 20 years after delivery

verfasst von: Ixora Kamisan Atan, Sylvia Lin, Hans Peter Dietz, Peter Herbison, Peter Donald Wilson, for the ProLong Study Group

Erschienen in: International Urogynecology Journal | Ausgabe 11/2018

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Abstract

Introduction and hypothesis

Levator ani muscle (LAM) and anal sphincter tears are common after vaginal birth and are associated with female pelvic organ prolapse and anal incontinence. The impact of subsequent births on LAM and external anal sphincter (EAS) integrity is less well defined. The objective of this study was to determine the prevalence of LAM and EAS trauma in primiparous (VP1) and multiparous (VP2+) women who had delivered vaginally to assess if there were differences between the two groups. The null hypothesis was: there is no significant difference in the prevalence of LAM and EAS trauma between the two groups.

Methods

This was a cross-sectional study involving 195 women, participants of the Dunedin arm of the ProLong study (PROlapse and incontinence LONG-term research study) seen 20 years after their index birth. Assessment included a standardized questionnaire, ICS POP-Q and 4D translabial ultrasound. Post-imaging analysis of LAM and EAS integrity was undertaken blinded against other data. Statistical analysis was performed using Fisher’s exact test and results were expressed as odds ratios (OR).

Results

LAM avulsion and EAS defects were diagnosed in 31 (16%) and 24 (12.4%) women respectively. No significant difference in the prevalence of levator avulsion and EAS defects between primiparous (VP1) and multiparous (VP2+) women who had delivered vaginally (OR 1.9, 95% CI 0.72–5.01, p = 0.26) and (OR 1.2, 95% CI 0.4–3.8, p = 0.76) respectively.

Conclusions

Most LAM avulsions and EAS defects seem to be caused by the first vaginal birth. Subsequent vaginal deliveries after the first were unlikely to cause further LAM trauma.
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Metadaten
Titel
It is the first birth that does the damage: a cross-sectional study 20 years after delivery
verfasst von
Ixora Kamisan Atan
Sylvia Lin
Hans Peter Dietz
Peter Herbison
Peter Donald Wilson
for the ProLong Study Group
Publikationsdatum
21.03.2018
Verlag
Springer London
Erschienen in
International Urogynecology Journal / Ausgabe 11/2018
Print ISSN: 0937-3462
Elektronische ISSN: 1433-3023
DOI
https://doi.org/10.1007/s00192-018-3616-4

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