Traumatismes du levator ani après l’accouchement, de l’étirement à l’avulsion : revue de la littérature - Inserm - Institut national de la santé et de la recherche médicale Accéder directement au contenu
Article Dans Une Revue Progrès en Urologie Année : 2013

[Levator ani trauma after childbirth, from stretch injury to avulsion: Review of the literature]

Traumatismes du levator ani après l’accouchement, de l’étirement à l’avulsion : revue de la littérature

Résumé

OBJECTIVE: Pelvic floor injuries as avulsion (disruption of the muscle) or overdistension were identified in 15 to 35% of deliveries. Our objective is to clarify the consequences of these muscles trauma on pelvic floor symptoms, pelvic organ prolapse and the management of postnatal assessment of pelvic floor function. METHOD: The literature search was conducted over a period from 2000 to January 2013 using the PubMed database and the following keywords: levator ani, ultrasound, magnetic resonance imaging, pelvic floor, obstetric trauma, pelvic organ prolapse, incontinence, delivery, avulsion. Seventy-four articles were identified, 43 were selected. The level of evidence was determined using the Oxford table. RESULTS: The instrumental extraction was found as the main risk factor with a prevalence of avulsions from 35% (NP3) to 72% (NP3) and an odd-ratio of 3.4 (NP3). Whatever the mode of assessment, the strength of the pelvic floor was reduced in 100% of cases of avulsion. Avulsions were diagnosed clinically and could be confirmed by ultrasound or MRI (correlation palpation imaging/k=0.497 (NP2) to 86% (NP3). An association was found with the risk of genital prolapse (odd-ratio from 2 [NP4] to 7 for prolapse grade 1 [NP4]) and fecal incontinence (16% [NP3] to 72% [NP4] with an odd-ratio of 14 [NP4]). CONCLUSION: This review has shown that obstetric muscle avulsions had an impact on pelvic organ prolapse and anal continence. The mode of the pelvic floor muscle postnatal assessment remains to be defined.
Fichier principal
Vignette du fichier
fichier_manuscrit_Billecoq.pdf (1.11 Mo) Télécharger le fichier
Origine : Fichiers produits par l'(les) auteur(s)
Loading...

Dates et versions

inserm-00846021 , version 1 (18-07-2013)

Identifiants

Citer

Sylvie Billecocq, Marie-Pascale Morel, Xavier Fritel. Traumatismes du levator ani après l’accouchement, de l’étirement à l’avulsion : revue de la littérature. Progrès en Urologie, 2013, 23 (8), pp.511-8. ⟨10.1016/j.purol.2013.04.003⟩. ⟨inserm-00846021⟩
624 Consultations
2045 Téléchargements

Altmetric

Partager

Gmail Facebook X LinkedIn More