Levator trauma after vaginal delivery

Obstet Gynecol. 2005 Oct;106(4):707-12. doi: 10.1097/01.AOG.0000178779.62181.01.


Objective: To date, the evidence on pelvic floor injury in labor remains sketchy due to a lack of prospective studies comparing pelvic floor imaging before and after childbirth. We intended to define the incidence of major trauma to the pubovisceral muscle.

Methods: A total of 61 nulliparous women were seen at 36-40 weeks of gestation in a prospective observational study. The assessment included an interview and 3-dimensional translabial ultrasound and was repeated 2-6 months postpartum.

Results: Fifty women (82%) were seen postpartum. Of the 39 women delivered vaginally, levator avulsion was diagnosed in 14 (36%, 95% confidence interval 21-51%). Among those delivered vaginally, there were associations with higher maternal age (P = .10), vaginal operative delivery (P = .07), and worsened stress incontinence postpartum (P = .02).

Conclusions: Avulsion of the inferomedial aspects of the levator ani from the pelvic sidewall occurred in approximately one third of all women delivered vaginally and was associated with stress incontinence 3 months after childbirth.

MeSH terms

  • Adult
  • Delivery, Obstetric*
  • Female
  • Follow-Up Studies
  • Humans
  • Imaging, Three-Dimensional
  • Parturition*
  • Pelvic Floor / diagnostic imaging
  • Pelvic Floor / injuries*
  • Pelvic Floor / physiopathology
  • Postpartum Period
  • Pregnancy
  • Prospective Studies
  • Ultrasonography
  • Urinary Incontinence, Stress / etiology