Early Anatomical Changes of Pelvic Support 1-Year After Levator Trauma: A Prospective Case-Control Study

Fragestellung: This prospective case-control study was carried out to assess possible anatomical signs and symptoms of POP 1-year after vaginal delivery in patients with LAM defect.

Methode: primiparous women with 3D ultrasound diagnosis of LAM trauma on 2^nd-3^rd day after vaginal delivery confirmed 1 year later were included in the cases (group A). Women with same criteria of inclusion, but with intact LAM, served as controls (group B). Prolapse symptoms were investigated with Australian Pelvic Floor Questionnaire. POP was assessed according to the pelvic organ prolapse quantification (POP-Q) system. Pelvic floor muscle strength was evaluated with Oxford Grading Scale.

Ergebnisse: forty patients were included, 20 with (group A) and 20 without (group B) levator trauma. In contrast to POP stage II and III, the occurrence of POP stage I was significantly higher in group A than in group B (p=0.003), with a strong positive association between POP stage I and LAM trauma (RR=7.2). A normal support of the vagina (stage 0) was significantly more frequent in group B than in group A (p<0.001). The involvement of multiple compartment (anterior and posterior compartment, p=0.003, p=0.01 respectively) was significantly higher in group A (Tab.1). The Oxford score showed no differences between the two groups (p=0.56).

Schlussfolgerung: this is the first prospective case-control study looking at morphological changes and symptoms of POP in patients with and without LAM trauma 1 year postpartum. At this follow-up period LAM trauma was asymptomatic in nearly all patients. However, our data demonstrated that early anatomical modifications of the pelvic support were found more frequently in patients with LAM trauma compared to women with intact LAM: a woman with LAM defect is seven times more likely to reveal a prolapse Stage I involving multiple compartments. An intact LAM seems to be protective against an initial process of genital descent.

Tab. 1: POP-Q evaluation

	Group A (n=20)	Group B (n=20)	Pv
POP stage 0	0	10 (50%)	<0.001
POP stage I	19 (95%)	10 (50%)	0.003
POP stage II	1 (5%)	0	1
POP stage III-IV	0	0	1
Anterior compartment involvement	19 (95%)	10 (50%)	0.003
Central compartment involvement	4 (20%)	0	0.1
Posterior compartment involvement	8 (40%)	0	0.01
Involvement of a single compartment	10 (50%)	9 (45%)	1
Involvement of multiple compartment	10 (50%)	1 (5%)	0.003

Data expressed as number (%).

Fig.1: Monolateral trauma of levator ani muscle after spontaneous delivery

Fig.2: Bilateral defect of levator ani muscle after vaginal delivery