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. 2010 Oct;111(1):19-22.
doi: 10.1016/j.ijgo.2010.05.019. Epub 2010 Jul 21.

Levator ani injury in primiparous women with forceps delivery for fetal distress, forceps for second stage arrest, and spontaneous delivery

Rohna Kearney  1 , Myra Fitzpatrick, Sandra Brennan, Michael Behan, Janis Miller, Declan Keane, Colm O'Herlihy, John O L DeLancey
Affiliations

Levator ani injury in primiparous women with forceps delivery for fetal distress, forceps for second stage arrest, and spontaneous delivery

Rohna Kearney et al. Int J Gynaecol Obstet. 2010 Oct.

Abstract

Objective: To compare levator ani muscle injury rates in primiparous women who had a forceps delivery owing to fetal distress with women delivered by forceps for second stage arrest; and to compare these injury rates with a historical control group of women who delivered spontaneously.

Methods: Primiparous women who delivered by forceps were recruited retrospectively into 2 groups: forceps for fetal distress with short second stage (25±11 minutes; n=19); and forceps delivery for second stage arrest (137±26 minutes; n=19). MR images of the levator ani muscles were compared with a historical control group of women from a previous study who had delivered spontaneously (n=129).

Results: Major defect rates were: 42% for forceps and short second stage; 63% for forceps and second stage arrest; and 6% for spontaneous delivery. The odds ratios for major injury were: 11.0 for forceps and short second stage compared with spontaneous delivery; 25.9 for forceps and second stage arrest compared with spontaneous delivery; and 2.3 for forceps and second stage arrest compared with short second stage (P=0.07).

Conclusion: Women delivered by forceps have a higher rate of levator ani injury compared with spontaneous delivery controls; the difference between the forceps groups did not reach significance.

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Conflict of interest statement

Conflict of interest

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Examples of the appearance of different grades of levator ani pubovisceral muscle defects in axial and coronal magnetic resonance images. Example A represents a woman with normal muscles; B and D represent women with major defects, and C, a woman with a minor defect. Defect scores in the left panels represent the scores for each side. Black arrows identify normal muscle and white arrows represent areas where muscle is defective or should be present. U, urethra; V, vagina; R, rectum. Reproduced, with permission, from Ref. [4].
Figure 2
Figure 2
Percentage of women with major, minor, and no levator ani defects among women who had forceps delivery and short second stage, forceps and second stage arrest, and spontaneous vaginal delivery. SVD, spontaneous vaginal delivery; SSS, short second stage; SSA, second stage arrest.
See this image and copyright information in PMC

References

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