Does delayed child‐bearing increase the risk of levator injury in labour?
- 6 November 2007
- journal article
- Published by Wiley in Australian and New Zealand Journal of Obstetrics and Gynaecology
- Vol. 47 (6), 491-495
- https://doi.org/10.1111/j.1479-828x.2007.00785.x
Abstract
Background: Levator trauma is common in parous women. We have recently found a relationship with age at first vaginal delivery in women seen before and after childbirth. Aims: To examine women presenting with symptoms of pelvic floor disorders for such an association. Methods: Eight hundred and one women were prospectively seen for an interview, clinical examination (including for levator integrity and function in 789 cases), multichannel urodynamic testing and pelvic floor ultrasound (including 3D imaging in 350 cases). Findings were tested for association with maternal age at first vaginal delivery, parity and operative vaginal delivery using logistic regression. Results: Mean age was 55.3 years (range 17–90), with 79% complaining of stress urinary incontinence and 28% of symptoms of prolapse. Median vaginal parity was 2 (range 0–12); mean age at first vaginal delivery was 24 (range 14–39). Levator defects were found in 170 women (21.6%), 24% of the vaginally parous. Defects were more common on the right (86%) than left (45%) (P < 0.0001). Women with levator trauma had a higher mean age (25.5 (SD 5.2) vs 23.5 (SD 4.5) years, P < 0.0001). Regression modelling confirmed findings, demonstrating an increase in the odds of levator trauma of approximately 10% for every year of delay in child‐bearing. Vaginal operative delivery was associated with a near‐doubling of the odds of trauma. Conclusions: Increased maternal age is a risk factor for intrapartum pelvic floor trauma. The global trend towards delayed child‐bearing may result in an increased prevalence of pelvic floor disorders in coming decades.Keywords
This publication has 21 references indexed in Scilit:
- Associations of Maternal Age- and Parity-Related Factors With Trends in Low-Birthweight Rates: United States, 1980 Through 2000American Journal of Public Health, 2006
- The prevalence of major abnormalities of the levator ani in urogynaecological patientsBJOG: An International Journal of Obstetrics and Gynaecology, 2006
- The assessment of levator trauma: A comparison between palpation and 4D pelvic floor ultrasoundNeurourology and Urodynamics, 2006
- Interrater reliability and physical examination of the pubovisceral portion of the levator ani muscle, validity comparisons using MR imagingNeurourology and Urodynamics, 2005
- Combined logistic and Bayesian modeling of cesarean section riskAmerican Journal of Obstetrics and Gynecology, 2004
- Ultrasound imaging of the pelvic floor. Part II: three‐dimensional or volume imagingUltrasound in Obstetrics & Gynecology, 2004
- Die Geburtenentwicklung in EuropaZeitschrift für Geburtshilfe und Neonatologie, 2002
- Can obstetric complications explain the high levels of obstetric interventions and maternity service use among older women? A retrospective analysis of routinely collected dataBJOG: An International Journal of Obstetrics and Gynaecology, 2001
- Third and fourth degree perineal tearsActa Obstetricia et Gynecologica Scandinavica, 2001
- Pelvic floor damage and childbirth: a neurophysiological studyBJOG: An International Journal of Obstetrics and Gynaecology, 1990