Abstract
There is an increasing awareness of maternal somatic birth trauma, which affects many more women than previously thought, primarily in the form of anal sphincter and levator ani tears. Given that such trauma occurs in about one-third of all women giving birth vaginally for the first time, and given that it has serious long-term consequences, it should be audited by all maternity services with a view to providing remedial therapy to delay or prevent subsequent morbidity, and to facilitate practice improvement. The increasing availability of modern imaging equipment and the skills of using it for pelvic floor assessment means that it is now becoming possible to provide such services postnatally.
Similar content being viewed by others
References
Mainz J (2003) Defining and classifying clinical indicators for quality improvement. Int J Qual Health Care 15(6):523–530
Singh R, Nath Trivedi A (2011) Is the caesarean section rate really a performance indicator of an obstetric unit? J Matern Fetal Neonatal Med 24(2):204–207
Sufang G, Padmadas S, Fengmin Z, Brown J, Stones R (2007) Delivery settings and caesarean section rates in China. Bull World Health Org 85(10):733–820
Menacker F, Hamilton BE (2010) Recent trends in cesarean delivery in the United States. US Department of Health and Human Services, Washington DC. http://www.cdc.gov/nchs/data/databriefs/db35.pdf. Accessed 9 Oct 2014
American College of Obstetricians and Gynecologists; Society for Maternal-Fetal Medicine (2014) Obstetric care consensus no. 1: Safe prevention of the primary cesarean delivery. Obstet Gynecol 123(3):693–711
Eason E, Labrecque M, Wells G, Feldman P (2000) Preventing perineal trauma during childbirth: a systematic review. Obstet Gynecol 95(3):464–471
Shek K, Dietz H (2010) Intrapartum risk factors of levator trauma. Br J Obstet Gynaecol 117:1485–1492
Cassado Garriga J, Pessarodona Isern A, Espuna Pons M, Duran Retamal M, Felgueroso Fabregas A, Rodriguez-Carballeira M (2011) Tridimensional sonographic anatomical changes on pelvic floor muscle according to the type of delivery. Int Urogynecol J 22:1011–1018
Chan S, Chung M, Wan O, Cheung R (2013) Levator ani muscle injury after instrumental delivery in Chinese primiparous women. Ultrasound Obstet Gynecol 42(S1):39
DeLancey J, Morgan D, Fenner D, Kearney R, Guire K, Miller J, Hussain H, Umek W, Hsu Y, Ashton-Miller J (2007) Comparison of levator ani muscle defects and function in women with and without pelvic organ prolapse. Obstet Gynecol 109(2):295–302
Poen AC, Felt-Bersma RJ, Dekker GA, Devillé W, Cuesta MA, Meuwissen SG (1997) Third degree obstetric perineal tears: risk factors and the preventive role of mediolateral episiotomy. Br J Obstet Gynaecol 104(5):563–566
MacArthur C, Glazener C, Lancashire R, Herbison GP, Wilson D, Grant AM (2005) Faecal incontinence and mode of first and subsequent delivery: a five year longitudinal study. Br J Obstet Gynaecol 112(8):1075–1082
Andrews V, Sultan AH, Thakar R, Jones PW (2006) Occult anal sphincter injuries – myth or reality? BJOG 113(2):195–200
Guzman Rojas R, Shek K, Langer S, Dietz H (2013) Prevalence of anal sphincter injury in primiparous women. Ultrasound Obstet Gynecol 42(4):461–466
Dietz HP (2009) Pelvic floor assessment: a review. Fetal Matern Med Rev 20:49–66
Krofta L, Otcenasek M, Kasikova E, Feyereisl J (2009) Pubococcygeus-puborectalis trauma after forceps delivery: evaluation of the levator ani muscle with 3D/4D ultrasound. Int Urogynecol J 20:1175–1181
Alcalay M, Brecher S, Kalter A, Schiff E, Eisenberg V (2011) Different patterns of pelvic floor dysfunction in forceps and vacuum deliveries. Int Urogynecol J 22(S1):S69–S70
Dietz H, Lanzarone V (2005) Levator trauma after vaginal delivery. Obstet Gynecol 106:707–712
Dietz H, Simpson J (2008) Levator trauma is associated with pelvic organ prolapse. Br J Obstet Gynaecol 115:979–984
Dietz HP, Chantarasorn V, Shek KL (2010) Levator avulsion is a risk factor for cystocele recurrence. Ultrasound Obstet Gynecol 36:76–80
Weemhoff M, Vergeldt T, Notten K, Serroyen J, Kampschoer P, Roumen F (2012) Avulsion of puborectalis muscle and other risk factors for cystocele recurrence: a 2-year follow-up study. Int Urogynecol J 23(1):65–71
Blasi I, Fuchs I, D'Amico R, Vinci V, La Sala G, Mazza V, Henrich W (2011) Intrapartum translabial three-dimensional ultrasound visualization of levator trauma. Ultrasound Obstet Gynecol 37(1):88–92
Albrich S, Laterza R, Skala C, Salvatore S, Koelbl H, Naumann G (2012) Impact of mode of delivery on levator morphology: a prospective observational study with 3D ultrasound early in the postpartum period. Br J Obstet Gynaecol 119(1):51–61
Chan S, Cheung R, Yiu A, Lee L, Pang A, Choy K, Leung T, Chung T (2012) Prevalence of levator ani muscle injury in Chinese primiparous women after first delivery. Ultrasound Obstet Gynecol 39(6):704–709
Leijonhufvud A, Lundholm C, Cnattingius S, Granath F, Andolf E, Altman D (2011) Risks of stress urinary incontinence and pelvic organ prolapse surgery in relation to mode of childbirth. Am J Obstet Gynecol 204(1):70.e71–70.e77
Mant J, Painter R, Vessey M (1997) Epidemiology of genital prolapse: observations from the Oxford Family Planning Association Study. Br J Obstet Gynaecol 104(5):579–585
DeLancey J (2005) The hidden epidemic of pelvic floor dysfunction: achievable goals for improved prevention and treatment. Am J Obstet Gynecol 192:1488–1495
Glazener C, MacArthur C, Bain C, Dean N, Toozs-Hobson P, Richardson K, Lancashire R, Herbison P, Hagen S, Grant A, Wilson D (2010) Epidemiology of pelvic organ prolapse in relation to delivery mode history at 12 years after childbirth: a longitudinal cohort study. Neurourol Urodyn 29(6):819–820
MacArthur C, Glazener C, Lancashire R, Herbison P, Wilson D (2011) Exclusive caesarean section delivery and subsequent urinary and faecal incontinence: a 12-year longitudinal study. Br J Obstet Gynaecol 118(8):1001–1007
Thomas V, Shek K, Guzman Rojas R, Dietz H (2013) The latency between pelvic floor trauma and presentation for prolapse surgery. Ultrasound Obstet Gynecol 42(S1):39
Smith F, Holman D, Moorin R, Tsokos N (2010) Lifetime risk of undergoing surgery for pelvic organ prolapse. Obstet Gynecol 116:1096–1100
Royal College of Obstetricians and Gynaecologists (2008) Good practice no. 7. Maternity Dashboard: clinical performance and governance score card. Royal College of Obstetricians and Gynaecologists, London.
Dietz H (2012) Female pelvic floor dysfunction – an imaging perspective. Nat Rev Gastroenterol Hepatol 9:113–121
Brown S, Lumley J (1998) Maternal health after childbirth: results of an Australian population based survey. Br J Obstet Gynaecol 105(2):156–161
Johnstone SJ, Boyce PM, Hickey AR, Morris-Yatees AD, Harris MG (2001) Obstetric risk factors for postnatal depression in urban and rural community samples. Aust N Z J Psychiatry 35(1):69–74
Dietz H (2007) Quantification of major morphological abnormalities of the levator ani. Ultrasound Obstet Gynecol 29:329–334
Dietz H, Shek K, Clarke B (2005) Biometry of the pubovisceral muscle and levator hiatus by three-dimensional pelvic floor ultrasound. Ultrasound Obstet Gynecol 25:580–585
Financial disclaimer/Conflicts of interest
H.P. Dietz: has received unrestricted educational grants from GE Medical. J. Pardey: nil. H. Murray: nil.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Dietz, H.P., Pardey, J. & Murray, H. Pelvic floor and anal sphincter trauma should be key performance indicators of maternity services. Int Urogynecol J 26, 29–32 (2015). https://doi.org/10.1007/s00192-014-2546-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00192-014-2546-z