Predicting levator avulsion from ICS POP-Q findings

Area of Science:

• Urogynecology
• Pelvic floor imaging
• Female pelvic organ prolapse

Background:

• Levator avulsion is a common childbirth injury linked to pelvic organ prolapse.
• Accurate diagnosis is challenging due to limited imaging availability.
• Early identification of avulsion is crucial for effective management and preventing recurrence.

Purpose of the Study:

• To evaluate the predictive value of the International Continence Society Pelvic Organ Prolapse Quantification (ICS POP-Q) for diagnosing levator avulsion.
• To assess the association between ICS POP-Q measurements and levator avulsion.
• To develop a clinical risk score for predicting levator avulsion.

Main Methods:

• Retrospective analysis of data from a tertiary urogynaecological unit.
• Standardized interviews, ICS POP-Q examinations, and 4D translabial pelvic floor ultrasound were performed.
• Multivariate logistic regression was used to identify predictors of avulsion, and a risk score was developed.

Main Results:

• ICS POP-Q components (Ba, C, gh, pb), previous prolapse repair, and forceps delivery were significantly associated with levator avulsion.
• A risk score effectively classified patients into low, moderate, and high-risk groups.
• The odds of avulsion were 12.8 times higher in the high-risk group compared to the low-risk group.

Conclusions:

• Levator avulsion is strongly associated with specific ICS POP-Q measurements.
• A simple scoring system incorporating ICS POP-Q and clinical data can predict the risk of levator avulsion.
• This risk score can enhance clinical suspicion and guide diagnostic approaches for levator avulsion.