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Levator Avulsion Is Associated With Pelvic Organ Prolapse 23 Years After the First Childbirth
Author(s) -
Atan Ixora Kamisan,
Lin Sylvia,
Dietz Hans P.,
Herbison Peter,
Wilson Peter D.
Publication year - 2018
Publication title -
journal of ultrasound in medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.574
H-Index - 91
eISSN - 1550-9613
pISSN - 0278-4297
DOI - 10.1002/jum.14641
Subject(s) - medicine , levator ani , pelvic floor , univariate analysis , avulsion , pelvic cavity , odds ratio , vaginal delivery , body mass index , surgery , childbirth , obstetrics , gynecology , pregnancy , multivariate analysis , biology , genetics
Objectives This study aimed to ascertain the association between levator avulsion and pelvic organ prolapse (POP). Methods This was a cross‐sectional study involving 195 women enrolled in a longitudinal cohort study and seen 20 years after an index birth. All had a standardized patient‐administered questionnaire, the International Continence Society Pelvic Organ Prolapse Quantification assessment and 4D translabial ultrasound. Main outcome measures were objective POP clinically and on translabial ultrasound. Postimaging assessment of levator integrity and sonographically determined pelvic organ descent was done blinded against other data. Results Of 195 women who were seen a mean of 23 (range, 19.4–46.2) years after their first birth, one declined ultrasound assessment and was excluded, leaving 194. Mean age was 50.2 (range 36.9–66.5) years with a mean body mass index (BMI) of 27.6 (range, 18.3–54.3) kg/m 2 . Median parity was 3 (range 1–14). Ninety‐one percent (n = 176) had delivered vaginally. Eighteen percent (n = 34) were symptomatic of prolapse. Clinically, 36% (n = 69) had significant POP. Levator avulsion was diagnosed in 16% (n = 31). Mean levator avulsion defect score was 2.2 (range, 0–12). On univariate analysis, levator avulsion and levator avulsion defect score were associated with clinically and sonographically significant POP, that is, odds ratio 2.6 (1.2–5.7), P = .01; and odds ratio 3.3 (1.4–7.7); P = .003, respectively; Ba ( P < .001); bladder ( P < .001); uterine ( P < .001) and rectal ampulla ( P = .009) descent, but not POP symptoms, C, and Bp. Multivariate analysis controlling for potential confounders confirmed our findings. Conclusions Levator avulsion is associated with female pelvic organ prolapse, especially of the anterior and central compartments. This association may become stronger with aging.