OC29.02: Do women notice the effect of levator trauma?

Abstract

Objectives: In 10–30% of women, vaginal birth results in levator ani tears which are associated with female pelvic organ prolapse and reduced contraction strength in later life. This study was undertaken to determine whether women notice such changes after childbirth. Methods: This is a retrospective analysis of two perinatal imaging studies. Patients were followed up 3–6 months postpartum. They were asked to estimate pelvic floor strength relative to strength just before childbirth, using a percentage. Translabial 4D pelvic floor ultrasound was performed to determine structure and function of the levator ani muscle. Imaging analysis was performed offline, using proprietary software, blinded against all clinical data. Levator avulsion was diagnosed on tomographic imaging in the axial plane. Results: 513 primiparous women were seen for follow-up in the context of two prospective trials, at a median of 129 days postpartum. They had given birth to a singleton at a mean gestation of 40.0 (range, 36+0 to 42+5). There were 351 vaginal deliveries (27 Forceps, 60 Vacuum and 264 NVD) and 162 Caesareans (31.6%). At follow-up, 482 were able to rate their pelvic floor strength relative to the situation prior to childbirth, reporting an average strength of 89%. This reduction was associated with delivery mode (P < 0.001), length of 2nd stage (P = 0.017) and episiotomy (P = 0.019). 45 women were diagnosed with levator avulsion which was associated with a greater reduction (no avulsion, 90% vs., unilateral avulsion, 86%, bilateral avulsion 80%, P= 0.007 on ANOVA). Conclusions: Many women notice altered pelvic floor function after childbirth. Vaginal childbirth, episiotomy, perineal tears and length of 2nd stage are associated with subjectively reduced pelvic floor strength after first delivery. Women who have suffered a levator avulsion notice a significantly greater reduction in subjective strength.