Livia Melnikova, Michaela Ostatnikova, Petra Psenkova, Zuzana Matusikova, Karin Kollarova, Veronika Serator, Lucia Borovska, Jozef Zahumensky
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The study evaluates the frequency and risk factors of avulsion injury of the levator ani muscle (LAM) in a group of 46 women after a successful vaginal delivery after a previous Caesarean section and 32 women after ERCS using 3D/4D transperineal ultrasound examination of the pelvic floor.</p><p><strong>Results: </strong>A total of 78 women were included in the study, 46 after VBAC and 32 after ERCS. In the first group, we recorded LAM avulsion injury in 13 cases (28.3 %); in the post-ERCS group, we did not record this injury (p < 0.0001). We also found an overdistended hiatal area (21.0 vs 19.4 cm2) and a more frequent occurrence of the area exceeding 25 cm2 (21.3 % vs 6.2 %, p = 0.0340) which was approaching the statistical significance. In the first group, we identified an increase in weight during pregnancy to 15 kg and a neonatal birthweight of 4,000 g or higher as risk factors for LAM injury.</p><p><strong>Conclusion: </strong>In the group of women with VBAC, there is a statistically significant risk of LAM avulsion and a higher occurrence of the overdistended area of the hiatus urogenitalis, especially in women with larger foetuses and in those who experienced greater weight gain during pregnancy (Tab. 3, Ref. 50). 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Women with a history of one Caesarean section were included in the study. They were divided into those who had a successful VBAC and those who delivered by ERCS. The mothers underwent a 3D/4D ultrasound examination of the pelvic floor muscles 3‒5 days after childbirth. The study evaluates the frequency and risk factors of avulsion injury of the levator ani muscle (LAM) in a group of 46 women after a successful vaginal delivery after a previous Caesarean section and 32 women after ERCS using 3D/4D transperineal ultrasound examination of the pelvic floor.</p><p><strong>Results: </strong>A total of 78 women were included in the study, 46 after VBAC and 32 after ERCS. In the first group, we recorded LAM avulsion injury in 13 cases (28.3 %); in the post-ERCS group, we did not record this injury (p < 0.0001). We also found an overdistended hiatal area (21.0 vs 19.4 cm2) and a more frequent occurrence of the area exceeding 25 cm2 (21.3 % vs 6.2 %, p = 0.0340) which was approaching the statistical significance. In the first group, we identified an increase in weight during pregnancy to 15 kg and a neonatal birthweight of 4,000 g or higher as risk factors for LAM injury.</p><p><strong>Conclusion: </strong>In the group of women with VBAC, there is a statistically significant risk of LAM avulsion and a higher occurrence of the overdistended area of the hiatus urogenitalis, especially in women with larger foetuses and in those who experienced greater weight gain during pregnancy (Tab. 3, Ref. 50). 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引用次数: 0
摘要
目的:本文的目的是确定剖腹产(VBAC)后阴道分娩的妇女与选择性重复剖腹产(ERCS)后阴道生产的妇女中提肛肌损伤的发生率,并确定危险因素联合国布拉迪斯拉发。有过一次剖腹产史的女性被纳入研究。他们被分为成功的VBAC患者和通过ERCS交付的患者。这些母亲在分娩后3-5天接受了盆底肌肉的3D/4D超声检查。这项研究评估了46名女性在前一次剖腹产后成功阴道分娩后和32名女性在ERCS后使用骨盆底3D/4D经会阴超声检查的肛门提肌撕脱伤的频率和危险因素。结果:共有78名女性被纳入研究,其中46名在VBAC后,32名在ERCS后。在第一组中,我们记录了13例LAM撕脱伤(28.3%);在ERCS后组中,我们没有记录这种损伤(p<0.0001)。我们还发现裂孔面积过大(21.0 vs 19.4 cm2),面积超过25 cm2的发生率更高(21.3%vs 6.2%,p=0.0340),接近统计学显著性。在第一组中,我们确定妊娠期体重增加到15公斤和新生儿出生体重增加到4000克或更高是LAM损伤的危险因素。结论:在患有VBAC的女性组中,LAM撕脱的风险具有统计学意义泌尿生殖道裂孔,尤其是胎儿较大的女性和怀孕期间体重增加较多的女性(表3,参考文献50)。PDF文本www.elis.sk关键词:盆底,提肛肌撕脱,剖腹产后阴道分娩。
Pelvic floor muscle injuries in women with a history of Caesarean section.
Objective: The aim of the paper is to determine the prevalence of levator ani muscle injuries and identify risk factors among women undergoing vaginal birth after Caesarean section (VBAC) compared to those with elective repeat Caesarean section (ERCS).
Material and methods: This prospective observational comparative study was conducted at the 2nd Clinic of Gynaecology and Obstetrics of FM CU and UN Bratislava. Women with a history of one Caesarean section were included in the study. They were divided into those who had a successful VBAC and those who delivered by ERCS. The mothers underwent a 3D/4D ultrasound examination of the pelvic floor muscles 3‒5 days after childbirth. The study evaluates the frequency and risk factors of avulsion injury of the levator ani muscle (LAM) in a group of 46 women after a successful vaginal delivery after a previous Caesarean section and 32 women after ERCS using 3D/4D transperineal ultrasound examination of the pelvic floor.
Results: A total of 78 women were included in the study, 46 after VBAC and 32 after ERCS. In the first group, we recorded LAM avulsion injury in 13 cases (28.3 %); in the post-ERCS group, we did not record this injury (p < 0.0001). We also found an overdistended hiatal area (21.0 vs 19.4 cm2) and a more frequent occurrence of the area exceeding 25 cm2 (21.3 % vs 6.2 %, p = 0.0340) which was approaching the statistical significance. In the first group, we identified an increase in weight during pregnancy to 15 kg and a neonatal birthweight of 4,000 g or higher as risk factors for LAM injury.
Conclusion: In the group of women with VBAC, there is a statistically significant risk of LAM avulsion and a higher occurrence of the overdistended area of the hiatus urogenitalis, especially in women with larger foetuses and in those who experienced greater weight gain during pregnancy (Tab. 3, Ref. 50). Text in PDF www.elis.sk Keywords: pelvic floor, levator ani muscle avulsion, vaginal birth after Caesarean section.
期刊介绍:
The international biomedical journal - Bratislava Medical Journal
– Bratislavske lekarske listy (Bratisl Lek Listy/Bratisl Med J) publishes
peer-reviewed articles on all aspects of biomedical sciences, including
experimental investigations with clear clinical relevance, original clinical
studies and review articles.