Tuesday, July 16, 2024

High Prevalence of Pelvic Floor Disorders Linked to Levator Ani Muscle Injuries Post Vaginal Delivery

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The relationship between vaginal delivery and pelvic floor disorders (PFDs) has long intrigued medical researchers. A recent systematic review highlights the significant influence of the first vaginal delivery on levator ani muscle (LAM) injuries in primiparous women, shedding light on the prevalence of these injuries and their long-term effects on PFDs. This study delves into the extent of LAM injuries, their prevalence over time, and their correlation with pelvic organ prolapse (POP) and sexual dysfunction, offering valuable insights for healthcare providers and policymakers focused on improving women’s health post-delivery.

Method and Findings

A systematic review adhering to the PRISMA methodology was conducted, utilizing databases such as PubMed, Cochrane, and PEDro. Quality assessment followed the Critical Appraisal Skills Programme (CASP). Two researchers performed the selection and evaluation of studies, with a third reviewer stepping in to resolve disagreements. Out of 57 articles initially gathered, 19 met the eligibility criteria.

The findings revealed that avulsion of the LAM is prevalent among women who have experienced vaginal delivery. Specifically, the prevalence ranged from 13% to 28% within one year post-delivery and between 16% and 29% beyond one year. Notably, ballooning was identified in 20% to 37% of women within the first year and in 33% of women after one year, suggesting a higher occurrence compared to avulsion.

Implications for Market Access

The study’s results underscore the critical need for accessible and comprehensive postnatal care services. Given the high prevalence of LAM injuries and their direct link to PFDs, it is imperative to enhance market access to specialized medical treatments and preventive measures. This includes wider availability of pelvic floor rehabilitation programs and advanced diagnostic tools to identify and manage these injuries early.

Pelvic organ prolapse emerged as the most common disorder associated with LAM injuries, with potential connections to sexual dysfunction. This highlights the importance of integrated healthcare solutions that address both physical and sexual health in postpartum women.

Concrete Insights

Key Points:

  • The prevalence of LAM avulsion post-vaginal delivery ranges from 13% to 29%, depending on the time elapsed since delivery.
  • Ballooning appears more common than avulsion, affecting up to 37% of women within the first year post-delivery.
  • Pelvic organ prolapse is the most frequently occurring disorder linked to LAM injuries.
  • There is an observable connection between LAM injuries and sexual dysfunction in some cases.
  • Enhanced market access to postnatal care and pelvic floor rehabilitation is crucial for better health outcomes.

The study concludes that the avulsion of the LAM and ballooning of the hiatal area are highly prevalent in primiparous women after vaginal delivery. These injuries have a strong direct relationship with the development of pelvic organ prolapse, underscoring the urgent need for targeted healthcare interventions and improved access to specialized postnatal care.

Original Article:

Neurourol Urodyn. 2024 Jul 1. doi: 10.1002/nau.25529. Online ahead of print.

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ABSTRACT

BACKGROUND: Studies show a significant association between the first vaginal delivery and injuries of the levator ani muscle (LAM), which can cause pelvic floor disorders (PFDs).

OBJECTIVES: This study aims to identify the prevalence of short and long-term LAM injuries after vaginal delivery in primiparous women and its influence on PFDs.

METHOD: A systematic review was conducted according to the PRISMA methodology. The databases used were Pubmed, Cochrane, and PEDro. The quality assessment of the evidence was carried out using the Critical Appraisal Skills Programme (CASP). Both the selection of studies and their evaluation were done by two researchers and a third reviewer in cases of disagreement.

RESULTS: From the search, 57 articles were gathered, and 19 were included to match the eligibility criteria. The prevalence of avulsion of the LAM was found in association with vaginal delivery between 13% and 28% ≤ 1 year after delivery and between 16% and 29% > 1 year after delivery. Ballooning was detected between 20% and 37% ≤ 1 year, and 33% of women > 1 year after delivery, appearing to be more common when compared to avulsion. Pelvic organ prolapse (POP) was considered the most common disorder associated with injuries of the LAM, and there seems to be some connection with sexual dysfunction.

CONCLUSION: Avulsion of the LAM and ballooning of the hiatal area have a high prevalence in primiparous women after vaginal delivery and have a strong direct relation to the development of POP.

PMID:38948963 | DOI:10.1002/nau.25529

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