TITLE:
Predicting Birth-Related Levator Ani Tear Severity in Primiparous Women: Evaluating Maternal Recovery from Labor and Delivery (EMRLD Study)
AUTHORS:
Lisa Kane Low, Ruth Zielinski, Yebin Tao, Andrzej Galecki, Catherine J. Brandon, Janis M. Miller
KEYWORDS:
Reproductive Physiological Phenomena; Birth Injuries; Parturition; Labor; Pelvic Floor Disorders; Soft Tissue Injuries of the Pelvis
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.4 No.6,
April
15,
2014
ABSTRACT:
Objective: To determine
which maternal characteristics or birth events independently predict severity
of levator ani muscle (LA) tears at first vaginal birth in a
longitudinal/observational investigation in a tertiary care hospital. Sample:
Ninety primiparas with at least
one at risk for LA tear inclusion factor at vaginal birth: maternal age ≥ 33
years, second stage ≥ 150 minutes, macrosomia, instrumented delivery, and/or
anal sphincter laceration were studied. Methods: Magnetic Resonance Imaging
(MRI) was obtained early postpartum (mean ± sd 48.9 ± 21.6 days) to identify LA
tear. Severity of LA muscle fiber loss was graded on an ordinal scale of: “0”
as no loss, “1” as p = 0.023; and time spent in active
pushing, OR 1.089 (CI 1.005 - 1.180), p = 0.038. The other factors considered
were not significant. There were too few women with forceps deliveries to
analyze. Conclusion: In our enriched sample of primiparous women, 26% showed a
significant LA tear. Maternal age and time spent actively pushing independently
predict LA tear severity.