Ceska Gynekol. 2022;87(3):173-178. doi: 10.48095/cccg2022173.
The aim of this multicentric observational study was to explore the impact of the timing of cesarean section (SC) on levator (MLA - levator ani musle) avulsion at the first subsequent vaginal birth.
All women after term vaginal birth following a cesarean section (VBAC) for their second delivery at the Departments of Gynecology and Obstetrics, Faculty of Medicine, Charles University and University Hospital in Pilsen and the 1st Faculty of Medicine, Charles University and General Hospital in Prague, between 2012 and 2016 were identified. Hospital database and surgical notes were used to collect basic characteristics of the patients including the indication and course of their previous delivery. These women were divided into two groups according to indication of prior SC in the previous delivery to women with elective SC and acute SC. All participants were invited for a 4D pelvic floor ultrasound to assess levator trauma. Levator avulsion and the levator hiatus area were assessed off-line from the stored pelvic floor volumes. Data were statistically assessed.
A total of 356 women had a VBAC for their second delivery during the study period. Of these, 152 (42.7%) attended the ultrasound examination and full data were available for 141 women for statistical analyses. These were further divided into 80 women after acute SC and 61 women after elective SC. The levator avulsion rate was higher in the elective SC subgroup, but the difference was not significant (26.3 vs. 41.0%, P = 0.0645). No statistical differences in urogenital hiatus enlargement and ballooning were observed.
VBAC is associated with a significantly higher rate of levator ani avulsion compared to the first vaginal birth in nulliparous women. However, it seems that risk of levator ani avulsion doesnt depend on the timing of SC in previous labor. More studies are needed to confirm the results of this pilot study.
本多中心观察性研究旨在探讨剖宫产术（CS）时机对首次阴道分娩时会阴体（MLA-会阴体肌肉）撕裂的影响。
在 2012 年至 2016 年期间，在查尔斯大学妇产科学系和普日布拉姆大学医院以及查尔斯大学第一医学院和布拉格综合医院，对所有因第二次分娩而接受经阴道剖宫产术（VBAC）的足月阴道分娩妇女进行了识别。使用医院数据库和手术记录收集了患者的基本特征，包括其前次分娩的指征和过程。这些妇女根据前次分娩 CS 的指征分为两组，一组为择期 CS，一组为急性 CS。所有参与者均被邀请进行 4D 盆底超声检查，以评估会阴体损伤。会阴体撕裂和会阴体裂孔面积从存储的盆底容积中离线评估。数据进行了统计学评估。
在研究期间，共有 356 名妇女因第二次分娩接受了 VBAC。其中，152 名（42.7%）参加了超声检查，141 名妇女的完整数据可用于统计分析。这些妇女进一步分为急性 CS 后 80 名和择期 CS 后 61 名。择期 CS 亚组的会阴体撕裂率较高，但差异无统计学意义（26.3%比 41.0%，P=0.0645）。未观察到尿生殖裂孔扩大和气球样扩张的统计学差异。
与初产妇的首次阴道分娩相比，VBAC 与更高的会阴体撕裂率相关。然而，会阴体撕裂的风险似乎并不取决于前次分娩时 CS 的时机。需要进一步的研究来证实本研究的结果。
