Woon Wong, K; Okeahialam, N; Thakar, R; Sultan, AH
(2024)
Obstetric risk factors for levator ani muscle avulsion: A systematic review and meta-analysis.
Eur J Obstet Gynecol Reprod Biol, 296.
pp. 99-106.
ISSN 1872-7654
https://doi.org/10.1016/j.ejogrb.2024.02.044
SGUL Authors: Sultan, Abdul Hameed
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Abstract
OBJECTIVES: Women have a 11% lifetime risk of undergoing surgery for vaginal prolapse. Levator ani muscle (LAM) avulsion is one etiological factor associated with primary and recurrent pelvic organ prolapse. Pelvic organ prolapse has been shown to greatly affect the quality of life and well-being of women. Conduct a meta-analysis identifying risk factors associated with LAM avulsion recognised on transperineal ultrasound (TPUS) or magnetic resonance imaging (MRI) in primiparous women after vaginal birth. STUDY DESIGN: OVID Medline, Embase and the Cochrane Library from inception to January 2021 were searched. Review Manager 5.3 (The Cochrane Collaboration) was used to analyse data. Odds ratios (OR) with 95% confidence intervals (95% CIs) were calculated. The heterogeneity among studies was calculated using the I2statistic. RESULTS: Twenty-five studies were eligible for inclusion (n = 9333 women). Major LAM avulsion was diagnosed in an average of 22 % (range 12.7-39.5 %) of cases. Twenty-two studies used TPUS and three used MRI to diagnose avulsion. Modifiable and non-modifiable risk factors were identified. Significant predictors identified were forceps (OR 6.25 [4.33 - 9.0]), obstetric anal sphincter injuries (OR 3.93 [2.85-5.42]), vacuum (OR 2.41 [1.40-4.16]), and maternal age (OR 1.06 [1.02-1.10]). CONCLUSIONS: This is the first meta-analysis of both modifiable and non-modifiable risk factors associated with LAM avulsion. This information could be used to develop a clinically applicable risk prediction model to target postnatal women at risk of LAM avulsion with a view to prevent the onset of pelvic floor organ prolapse.
Item Type: | Article | ||||||||
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Additional Information: | © 2024 The Author(s). Published by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). | ||||||||
Keywords: | Childbirth, Forceps, Levator ani muscle avulsions, Meta-analysis, Risk factors, Transperineal ultrasound, 1114 Paediatrics and Reproductive Medicine, Obstetrics & Reproductive Medicine | ||||||||
SGUL Research Institute / Research Centre: | Academic Structure > Institute of Medical & Biomedical Education (IMBE) | ||||||||
Journal or Publication Title: | Eur J Obstet Gynecol Reprod Biol | ||||||||
ISSN: | 1872-7654 | ||||||||
Language: | eng | ||||||||
Dates: |
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PubMed ID: | 38422805 | ||||||||
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URI: | https://openaccess.sgul.ac.uk/id/eprint/116328 | ||||||||
Publisher's version: | https://doi.org/10.1016/j.ejogrb.2024.02.044 |
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