Birthweight and pelvic floor trauma after vaginal childbirth

Author(s)

Martinho, Natalia ^[1] ; Friedman, Talia ^[2] ; Turel, Friyan ^[2] ; Robledo, Kirsty ^[3] ; Riccetto, Cassio ^[1] ; Dietz, Hans Peter ^{[2, 4]}

Affiliation

^[1] State Univ Campinas UNICAMP, Fac Med Sci, Campinas, SP - Brazil

^[2] Univ Sydney, Sydney Med Sch Nepean, Sydney, NSW - Australia

^[3] Univ Sydney, NHMRC Clin Trials Ctr, Sydney, NSW - Australia

^[4] Nepean Hosp, Sydney Med Sch Nepean, Penrith, NSW 2750 - Australia

• Document type: Journal article
• Source: INTERNATIONAL UROGYNECOLOGY JOURNAL; v. 30, n. 6, p. 985-990, JUN 2019.
• Web of Science Citations: 0

Abstract

Introduction and hypothesisBirthweight seems to be a risk factor for levator ani muscle (LAM) avulsion and a predictive factor for pelvic organ prolapse (POP). Most trauma seems due to first vaginal birth.MethodsOne thousand one hundred twenty-five women with at least two vaginal deliveries underwent a physician-directed interview, followed by clinical examination (digital palpation and Pelvic Organ Prolapse Quantification-POPQ) and 4D translabial ultrasound. Ultrasound volume data were obtained at rest, on pelvic floor contraction and Valsalva. The investigator, blinded to all other data, performed offline analysis of the LAM integrity and hiatal area on Valsalva. We tested for associations between birthweight of the first and of the largest vaginally born baby on the one hand and avulsion and symptoms/signs of prolapse on the other hand.ResultsBetween July 2014 and July 2017, 1575 patients were seen. After exclusion of nulliparae and women with just one vaginal birth, 1202 remained. Another 77 were excluded due to missing data, leaving 1125. A significant association was found between birthweight and LAM avulsion as well as significant prolapse on POPQ. The birthweight of the first vaginally born baby was at least as predictive for avulsion as the birthweight of any subsequent births, even when adjusted for maternal age at first delivery and use of forceps.ConclusionsThe birthweight of the first vaginally born baby is associated with levator avulsion and subsequent POP. Maximum weight of vaginal births does not seem to be a stronger predictor. (AU)

• FAPESP's process: 15/22521-8 - Co-activation analysis between the abdominal and pelvic floor muscles and its relationship with the pelvic floor's ultrasound biometric parameters in women with predominantly stress urinary incontinence
• Grantee: Natalia Miguel Martinho Fogaça
• Support Opportunities: Scholarships in Brazil - Doctorate
• FAPESP's process: 17/02565-6 - Study of the functional anatomy of the female pelvic floor through 3D/4D transperineal ultrasound
• Grantee: Natalia Miguel Martinho Fogaça
• Support Opportunities: Scholarships abroad - Research Internship - Doctorate