LEVATOR ANI DEFECTS IN PRIMIPAROUS WOMEN WITH TIME OF DELIVERY BEFORE OR AFTER THE FINNISH INTERVENTION
Author
Henriksen, Josefine Lin Pedersen
Term
5. Term (Master thesis)
Education
Publication year
2022
Pages
15
Abstract
Background: The Finnish intervention, introduced in 2013 at the North Denmark Regional Hospital, lowered obstetric anal sphincter injuries but could theoretically increase strain on the levator ani muscles and the risk of levator ani defects (LAD), which are linked to prolapse and urinary incontinence. Objective: To compare LAD prevalence, objective prolapse findings, and urogynecological symptoms among primiparous women delivering before versus after the intervention. Methods: Primiparous women with singleton vaginal births at the hospital from 2008–2018 were identified and invited. Participants underwent POP-Q examination, 3D endovaginal ultrasound of the pubovisceralis and puborectalis with defect scoring (0–3 per side; classified as none, mild, or major defect), and completed the ICIQ-UI-SF and ICIQ-VS questionnaires. A total of 112 women were included (36 before, 76 after). Results: No significant differences were found between cohorts in age, BMI, or prior surgery; time from delivery to inclusion differed. There were no differences in prolapse types or grades, subjective symptoms, or LAD prevalence between groups. Overall LAD prevalence was relatively high, up to about 50%. Conclusion: The Finnish intervention did not alter the presence of levator ani defects. Given the high LAD prevalence and reported urogenital symptoms in both groups, further research is warranted.
Baggrund: Det finske håndgreb, indført i 2013 på Regionshospital Nordjylland, reducerede incidensen af anale sphincterrupturer, men kunne teoretisk øge belastningen af levator ani-musklerne og dermed risikoen for levator ani-defekter (LAD), som er associeret med prolaps og urininkontinens. Formål: At sammenligne forekomst af LAD, objektive tegn på prolaps og urogynækologiske symptomer blandt primipara, der fødte før versus efter implementeringen af håndgrebet. Metoder: Primipara med enkeltstående vaginal fødsel på Regionshospital Nordjylland 2008–2018 blev identificeret og inviteret. Deltagerne gennemgik POP-Q-undersøgelse, 3D endovaginal ultralyd af pubovisceralis og puborectalis med defektscoring (0–3 per side; klassificeret som ingen, mild eller stor defekt), samt udfyldte ICIQ-UI-SF og ICIQ-VS. I alt indgik 112 kvinder (36 før, 76 efter). Resultater: Der var ingen signifikante forskelle mellem kohorterne i alder, BMI eller tidligere operationer; tiden fra fødsel til inklusion var forskellig. Der sås ingen forskel i prolaps-typer eller -grader, subjektive symptomer eller forekomst af LAD mellem grupperne. Den overordnede forekomst af LAD var relativt høj, op mod cirka 50%. Konklusion: Det finske håndgreb påvirkede ikke tilstedeværelsen af levator ani-defekter. Da LAD og urogenitale gener var hyppige i begge grupper, er der behov for yderligere forskning.
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