Do some levator avulsions improve over time?

IF 6.1 1区 医学 Q1 ACOUSTICS Ultrasound in Obstetrics & Gynecology Pub Date : 2024-12-01 DOI:10.1002/uog.27702
H P Dietz, K L Shek, J Descallar
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Abstract

Objective: To determine whether the sonographic appearance of levator ani muscle avulsion after vaginal birth can improve significantly over the first few years postpartum.

Methods: This was a retrospective study of women seen in the context of two prospective perinatal imaging studies. All subjects had undergone an interview, clinical examination and four-dimensional translabial ultrasound on average 4.3 months and 3.1 years postpartum. Volume datasets were analyzed at a later date, with the examiner blinded against all other data. The number of abnormal slices at both timepoints was compared using the Mann-Whitney U-test. Patients in whom findings had changed over time were reviewed separately, in parallel, in order to reduce the impact of differences in slice location and imaging settings. The symmetry test was used to analyze changes between the two postnatal visits.

Results: Of 1148 women recruited originally, 315 attended at least two postnatal visits. Forty-two were excluded, leaving 273 women for the final analysis. The mean time of first follow-up was 4.3 (range, 2.6-9.8) months after their first birth and the mean time of last follow-up was 3.1 (range, 1.4-8.0) years postpartum. Cohen's κ for the category of avulsion (normal, partial avulsion and full avulsion) at the two assessments was 0.89, with agreement in 97% (264/273) of cases. At the first visit, full levator ani muscle avulsion was diagnosed in 20, partial avulsion in 32 and no avulsion in 221 women. While seven partial avulsions appeared sonographically normal at the second visit, there were no statistically significant changes in avulsion category between visits (P = 0.4).

Conclusions: Tomographic pelvic floor imaging obtained 3-10 months after childbirth may be used as a proxy for long-term outcomes. Ultrasound findings at a mean of 3.1 years postpartum showed 97% agreement with findings obtained on imaging at a mean of 4.3 months postpartum. There was a non-significant reduction in abnormal slices at the second follow-up visit, affecting at most 3/12 slices. This may be explained by compensatory hypertrophy of the remaining intact muscle. Sonographic normalization of full levator ani muscle avulsion was not observed. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.

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有些提上睑肌撕脱会随着时间的推移而好转吗?
目的确定阴道分娩后出现的提上睑肌撕裂的声像图外观在产后最初几年是否会明显改善:方法:对在两项前瞻性围产期成像研究中就诊的妇女进行回顾性研究。所有受试者分别在产后平均 4.3 个月和 3.1 年接受了访谈、临床检查和四维平滑肌超声检查(TLUS)。随后,在对所有其他数据进行盲法分析的基础上,对切片数据集进行了分析。使用 Mann- Whitney U 检验比较两个时间点的异常切片数量。为了减少切片位置和成像设置差异的影响,对结果随时间发生变化的患者分别进行了平行复查。对称性检验用于分析产后两次检查之间的变化:在最初招募的 1148 名妇女中,有 315 人至少接受过两次产后检查。42 人被排除在外,剩下 273 名妇女接受了分析。这些妇女平均在产后 4.3 个月(2.6-9.8 个月)接受首次检查,最后一次检查在产后 3.1 年(1.4-8 年)。两次评估的 Cohen's kappa 为 0.89,97%(264/273)的病例结果一致。首次就诊时,20 例被诊断为完全撕脱,32 例为部分撕脱,221 例为无撕脱。第二次就诊时,有 7 例部分撕脱在声像图上显示正常,但两次就诊之间撕脱类别的变化无统计学意义(P=0.4):结论:产后 2.5-10 个月进行的盆底断层扫描成像可作为长期结果的代表。平均 3.1 年的检查结果与平均 4.3 个月的造影结果显示出 97% 的一致性。最多影响 3/12 个切片的异常切片显著减少。这可能是由于剩余的完整肌肉代偿性肥大所致。没有观察到完全撕脱的声像正常化。本文受版权保护。保留所有权利。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
12.30
自引率
14.10%
发文量
891
审稿时长
1 months
期刊介绍: Ultrasound in Obstetrics & Gynecology (UOG) is the official journal of the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) and is considered the foremost international peer-reviewed journal in the field. It publishes cutting-edge research that is highly relevant to clinical practice, which includes guidelines, expert commentaries, consensus statements, original articles, and systematic reviews. UOG is widely recognized and included in prominent abstract and indexing databases such as Index Medicus and Current Contents.
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