A review of levator ani avulsion after childbirth: Incidence, imaging and management. (December 2022)

• Record Type: Journal Article
• Authors: Doxford-Hook, Elizabeth; Downey, Candice; Gibson, Joanna; Marsh, Fiona
• Is Part Of: Midwifery. Volume 115(2022)
• Publication Date: 2022-12
• Subjects: Levator ani muscle -- Levator ani muscle avulsion -- Pelvic organ prolapse, Urogynaecology; Midwifery -- Periodicals; Midwifery -- Periodicals; Sages-femmes -- Périodiques; Midwifery; Periodicals; Electronic journals; 618.2005
• DOI: 10.1016/j.midw.2022.103494
• Languages: English
• ISSNs: 0266-6138

Abstract

Highlights: Levator ani muscle (LAM) avulsion injury occurs occultly during childbirth, most commonly during operative vaginal deliveries. Injuries of levator ani muscle have long term sequelae for pelvic floor health for example incontinence of urine or faeces, prolapse and pain. Diagnosis of this condition can be difficult as there is no agreed 'gold standard' imaging modality. There is also no consensus regarding surgical management of LAM avulsion. This condition has a profound impact on new mothers quality of life and we currently cannot treat it well, therefore focus should be on prevention. Abstract: Key Content Levator ani muscle (LAM) avulsion injury occurs occultly during childbirth, most commonly during operative vaginal deliveries. Injuries of levator ani have long term sequelae for pelvic floor health. As life expectancy increases the burden of disease upon urogynaecology services will need to be considered. Diagnosis of this condition can be difficult as there is no agreed 'gold standard' imaging modality. There is no consensus regarding surgical management of LAM avulsion. Learning objectives Review anatomy and function of levator ani muscle Identify the risk factors for levator ani avulsion injury Role of imaging to appropriately identify LAM injury and current management options including appropriate follow up Management of subsequent pregnancy following LAM avulsion Ethical issues Is there value to the patient in diagnosing levator ani avulsion when there is no recommended treatment for these injuries?