Department of Obstetrics and Gynaecology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic.
Biomedical Centre, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic.
BJOG. 2022 Mar;129(4):517-528. doi: 10.1111/1471-0528.16837. Epub 2021 Aug 1.
There is variation in the reported incidence rates of levator avulsion (LA) and paucity of research into its risk factors.
To explore the incidence rate of LA by mode of birth, imaging modality, timing of diagnosis and laterality of avulsion.
We searched MEDLINE, EMBASE, CINAHL, AMED and MIDIRS with no language restriction from inception to April 2019.
A study was included if LA was assessed by an imaging modality after the first vaginal birth or caesarean section. Case series and reports were not included.
RevMan v5.3 was used for the meta-analyses and SW SAS and STATISTICA packages were used for type and timing of imaging analyses.
We included 37 primary non-randomised studies from 17 countries and involving 5594 women. Incidence rates of LA were 1, 15, 21, 38.5 and 52% following caesarean, spontaneous, vacuum, spatula and forceps births, respectively, with no differences by imaging modality. Odds ratio of LA following spontaneous birth versus caesarean section was 10.69. The odds ratios for LA following vacuum and forceps compared with spontaneous birth were 1.66 and 6.32, respectively. LA was more likely to occur unilaterally than bilaterally following spontaneous (P < 0.0001) and vacuum-assisted (P = 0.0103) births but not forceps. Incidence was higher if assessment was performed in the first 4 weeks postpartum.
LA incidence rates following caesarean, spontaneous, vacuum and forceps deliveries were 1, 15, 21 and 52%, respectively. Ultrasound and magnetic resonance imaging were comparable tools for LA diagnosis.
Levator avulsion incidence rates after caesarean, spontaneous, vacuum and forceps deliveries were 1, 15, 21 and 52%, respectively.
阴道分娩和剖宫产术中发生会阴撕裂（LA）的报道发生率存在差异，且其风险因素的研究也很少。
通过分娩方式、影像学检查方式、诊断时机和撕裂侧别的不同，探讨 LA 的发生率。
我们对 MEDLINE、EMBASE、CINAHL、AMED 和 MIDIRS 进行了检索，无语言限制，检索时间从建库至 2019 年 4 月。
如果 LA 通过影像学检查在首次阴道分娩或剖宫产术后评估，研究即可被纳入。病例系列和报告不包括在内。
RevMan v5.3 用于荟萃分析，SW SAS 和 STATISTICA 包用于影像学分析的类型和时机。
我们纳入了来自 17 个国家的 37 项初级非随机研究，涉及 5594 名女性。剖宫产、自然分娩、真空吸引、产钳和匙刮术分娩后 LA 的发生率分别为 1%、15%、21%、38.5%和 52%，影像学检查方式之间无差异。与剖宫产相比，自然分娩发生 LA 的比值比为 10.69。与自然分娩相比，真空吸引和产钳分娩发生 LA 的比值比分别为 1.66 和 6.32。与自然分娩和真空吸引相比，LA 更可能单侧发生（P<0.0001；P=0.0103），而不是双侧发生，但产钳不是。如果在产后 4 周内进行评估，发生率更高。
剖宫产、自然分娩、真空吸引和产钳分娩后 LA 的发生率分别为 1%、15%、21%和 52%。超声和磁共振成像都是 LA 诊断的可靠工具。
剖宫产、自然分娩、真空吸引和产钳分娩后 LA 的发生率分别为 1%、15%、21%和 52%。
