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Levator ani avulsion: a Systematic evidence review (LASER)
Z. Rusavy, L. Paymova, M. Kozerovsky, A. Veverkova, V. Kalis, RA. Kamel, KM. Ismail
Language English Country Great Britain
Document type Journal Article, Research Support, Non-U.S. Gov't, Systematic Review
Grant support
Progres Q39
Charles University Research Fund
918119
Charles University Grant Agency
CZ.02.1.01/0.0/0.0/16_019/0000787
Ministry of Education, Youth and Sports of the Czech Republic
The European Regional Development Fund
- MeSH
- Cesarean Section adverse effects statistics & numerical data MeSH
- Incidence MeSH
- Humans MeSH
- Pelvic Floor Disorders epidemiology etiology MeSH
- Pregnancy MeSH
- Vacuum Extraction, Obstetrical adverse effects statistics & numerical data MeSH
- Check Tag
- Humans MeSH
- Pregnancy MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Systematic Review MeSH
BACKGROUND: There is variation in the reported incidence rates of levator avulsion (LA) and paucity of research into its risk factors. OBJECTIVE: To explore the incidence rate of LA by mode of birth, imaging modality, timing of diagnosis and laterality of avulsion. SEARCH STRATEGY: We searched MEDLINE, EMBASE, CINAHL, AMED and MIDIRS with no language restriction from inception to April 2019. STUDY ELIGIBILITY CRITERIA: A study was included if LA was assessed by an imaging modality after the first vaginal birth or caesarean section. Case series and reports were not included. DATA COLLECTION AND ANALYSIS: RevMan v5.3 was used for the meta-analyses and SW SAS and STATISTICA packages were used for type and timing of imaging analyses. RESULTS: We included 37 primary non-randomised studies from 17 countries and involving 5594 women. Incidence rates of LA were 1, 15, 21, 38.5 and 52% following caesarean, spontaneous, vacuum, spatula and forceps births, respectively, with no differences by imaging modality. Odds ratio of LA following spontaneous birth versus caesarean section was 10.69. The odds ratios for LA following vacuum and forceps compared with spontaneous birth were 1.66 and 6.32, respectively. LA was more likely to occur unilaterally than bilaterally following spontaneous (P < 0.0001) and vacuum-assisted (P = 0.0103) births but not forceps. Incidence was higher if assessment was performed in the first 4 weeks postpartum. CONCLUSIONS: LA incidence rates following caesarean, spontaneous, vacuum and forceps deliveries were 1, 15, 21 and 52%, respectively. Ultrasound and magnetic resonance imaging were comparable tools for LA diagnosis. TWEETABLE ABSTRACT: Levator avulsion incidence rates after caesarean, spontaneous, vacuum and forceps deliveries were 1, 15, 21 and 52%, respectively.
Biomedical Centre Faculty of Medicine in Pilsen Charles University Pilsen Czech Republic
Department of Obstetrics and Gynaecology University Hospital Pilsen Czech Republic
Maternal Fetal Medicine Unit Department of Obstetrics and Gynaecology Cairo University Cairo Egypt
References provided by Crossref.org
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