Levator Ani Muscle Avulsion After Vaginal Delivery Comparing Routine Versus Restrictive Episiotomy: A Pilot Study

Area of Science:

• Obstetrics and Gynecology
• Pelvic Floor Disorders
• Surgical Techniques

Background:

• Episiotomy is a common procedure during vaginal delivery.
• Levator ani muscle avulsion is a significant complication affecting pelvic floor function.
• The impact of routine versus restrictive episiotomy on levator ani avulsion requires further investigation.

Purpose of the Study:

• To compare the incidence of levator ani muscle avulsion following vaginal birth.
• To evaluate the effect of routine episiotomy versus restrictive episiotomy on levator ani avulsion.
• To assess pelvic floor ultrasound parameters in relation to episiotomy protocols.

Main Methods:

• A randomized controlled trial involving two cohorts of pregnant women.
• Prospective enrollment between September 2015 and December 2017 at a university hospital.
• Levator ani avulsion assessed via four-dimensional ultrasound screening.

Main Results:

• No significant difference in levator ani avulsion rates between routine (9.4%) and restrictive (10.3%) episiotomy groups.
• Anal sphincter tear rates were comparable: 12.5% (routine) vs. 13.8% (restrictive).
• No statistical differences observed in pelvic floor parameters like bladder neck descent or genital hiatus ballooning.

Conclusions:

• Restrictive episiotomy did not reduce the rate of levator ani avulsion compared to routine episiotomy in this pilot study.
• No significant differences in pelvic floor ultrasound parameters were found between the two episiotomy protocols.
• Further research is needed to confirm these findings in larger populations.