Labor Delivery, Levator Ani Avulsion, Postpartum, Time of the Crowning of the Fetal Head
Conditions
Keywords
levator ani, levator ani avulsion, crowning time, crowning time of the fetal head, primiparous, singleton foetus, vertex position, postpartum
Brief summary
Levator ani muscle is one of the main components of perineal muscles and plays a crucial role in urinary continence and pelvic organ support. An avulsion, detachment from its insertion, of this muscle can occur during vaginal birth. It is well known that this major injury can cause many symptoms such as urinary incontinence and pelvic organ prolapses. Some risk factors of this important injury have been identified in the literature, such as the use of forceps. However, to date, no study has evaluated the impact of the crowning of the fetal head during labor on perineal muscles, specifically the levator ani muscle avulsion. Hence, the objectives of this study are to evaluate the association i) the time of the crowning of the fetal head during labor and levator ani muscle avulsion, ii) the time of the crowning of the fetal head and urogynecological symptoms, and iii) use of episiotomy and levator ani muscle avulsion. Postpartum primiparous women will undergo a 4D transperineal ultrasound to evaluate their pelvic muscles and complete questionnaires assessing urogynecological symptoms.
Detailed description
This is a prospective cohort study evaluating the impact of the crowning time of the fetal head in the second stage of labor on the incidence of levator ani muscle avulsion. Levator ani muscle is hypothesized to avulse during the distension of the pelvic floor muscles, as during a forceps use, and most probably during the crowning of the fetal head. In the study center, the crowning of the fetal head is systematically calculated during labor by nurses and doctors. To eliminate some potential confounding factors, only primiparous women with spontaneous vaginal delivery of a vertex position baby will be recruited in the post-partum period. In order to evaluate the presence of levator ani muscle avulsion, they will be assessed with a 4D transperineal ultrasound by using a standard diagnosis protocol. The delivery hospital file will then be examined to collect potential confounding variables. Prior to data collection, all study participants will give their written informed consent. This study will add more literature to the prevention of the levator ani muscle avulsion and its long-term complications.
Interventions
None listed
Sponsors
Centre de recherche du Centre hospitalier universitaire de Sherbrooke
Université de Sherbrooke
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
FEMALE
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
Primiparous women GxT1 At term: ≥ 37+0 weeks of gestation (included) Spontaneous vaginal delivery (SVD) Cephalic presentation History of miscarriage before 20 weeks or with a fetal weight \< 350g
Exclusion criteria
Contraindications to vaginal delivery Assisted vaginal delivery Age under 18 years Shoulder dystocia Extensive pelvic reconstructive surgery (e.g., bladder exstrophy repair) Term intrauterine fetal demise Twin or multifetal pregnancy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of participants with complete and partial unilateral or bilateral avulsion of the levator ani muscles in the post-partum period | In the post-partum period, up to 1 year post-partum | Diagnostic established with standard levator-urethra gap measures assessed with a transperineal 4D ultrasound |
| Crowning time of the fetal head | The data was obtained from the medical records of each participant during labor. | The time between the crowning of the fetal head and birth is systematically recorded during labor at the study center for all deliveries. Only participants who meet the inclusion criteria are considered for the study. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Rate and type of perineal tears | The data was obtained from the medical records of each participant during labor. | Grade of perineal tear collected in the medical file |
| Incidence and severity of urogynecological symptoms | In the post-partum period, up to 1 year post-partum | Validated questionnaires on urogynecological symptoms: PFDI-46 and ICIQ-IU-SF PFDI-46 (Pelvic Floor Distress Inventory - 46 Items) Full title: Pelvic Floor Distress Inventory Structure & Scoring: It comprises three subscales: 1. UDI (Urinary Distress Inventory): range 0-300 2. POPDI (Pelvic Organ Prolapse Distress Inventory): range 0-300 3. CRADI (Colorectal-Anal Distress Inventory): range 0-400 Interpretation: Higher scores indicate worse symptom distress-i.e., a higher burden of pelvic floor symptom ICIQ-UI-SF (International Consultation on Incontinence Questionnaire - Urinary Incontinence Short Form) Full title: International Consultation on Incontinence Questionnaire - Urinary Incontinence Short Form Scoring: Total score: 0-21 (sum of items 3, 4, and 5; items 1, 2 are demographic, one item is unscored) Interpretation: A higher score indicates greater severity of urinary incontinence and a greater negative impact on quality of life |
| Use of episiotomy | The data was obtained from the medical records of each participant during labor. | Type and use of episiotomy collected in the medical file |
Countries
Canada
Contacts
Primary ContactMegan Boutilier, resident in OBGYN, Medical Degree
Backup ContactMarie-Élisabeth Bouchard, MD, Urogynecologist
Outcome results
None listed