Change in prevalence of major levator ani muscle defects from six weeks to one year postpartum, and maternal and obstetric risk factors: a longitudinal ultrasound study.

INTRODUCTION: The present study aimed first to investigate the change in prevalence of major levator ani muscle (LAM) defects, also called avulsions, from six weeks to one year postpartum, and second to assess maternal and obstetric risk factors for having persistent major LAM defects/avulsions at one year postpartum. MATERIAL AND METHODS: This is a secondary analysis of data from a prospective cohort study including 300 nulliparous women at 17-19 weeks of gestation. Major LAM defects were diagnosed at six weeks and one year postpartum using transperineal ultrasonography. We defined persistent major LAM defects as a defect diagnosed both at six weeks and one year postpartum. Maternal and obstetric data were obtained from the hospital's electronic birth records. Pelvic floor muscle function was measured vaginally by manometer at 22 weeks of gestation. Main outcome measurement was change in prevalence of major LAM defects. Maternal and obstetric risk factors for having persistent major LAM defect were also assessed. RESULTS: Prevalence of major LAM defects was 19.4% at six weeks and 10.4% at one year postpartum. No new major LAM defects were diagnosed at one year postpartum. Persisting major LAM defects were associated with longer second stage of labor (median 74.5 minutes versus median 48.0 minutes, p =0.012) and higher neonatal birthweight (mean difference of 232.3 grams, 95% CI 21.5-443.1). Vacuum delivery was independently associated with persistent major LAM defects, adjusted OR 3.0 (95% CI (1.0-9.0). CONCLUSIONS: There was a 50% reduction of sonographically diagnosed major LAM defects from six weeks to one year postpartum. This finding suggests that assessment of the major LAM six weeks postpartum may be too early for diagnosing defects/avulsions. Long second stage of labor, high neonatal birthweight and vacuum delivery were associated with persistent major LAM defects/avulsions.