IMR Press / CEOG / Volume 49 / Issue 5 / DOI: 10.31083/j.ceog4905118
Open Access Systematic Review
Diagnosis of Levator Ani Muscle Avulsion in Instrumented Delivery: Meta-analysis
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1 Department of Obstetrics and Gynecology, Valme University Hospital, 41014 Seville, Spain
2 Department of Obstetrics and Gynecology, University of Seville, 41014 Seville, Spain
3 Biostatistics Unit, Department of Preventive Medicine and Public Health, University of Seville, 41009 Seville, Spain
4 Department of Cardiology, Virgen del Rocio University Hospital, 41013 Seville, Spain
*Correspondence: (José Antonio García-Mejido); (Ana Fernández-Palacín)
Academic Editor: Stefano Manodoro
Clin. Exp. Obstet. Gynecol. 2022, 49(5), 118;
Submitted: 1 March 2022 | Revised: 18 March 2022 | Accepted: 22 March 2022 | Published: 18 May 2022
(This article belongs to the Special Issue Delivery and Pelvic Floor Disorders)
Copyright: © 2022 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.

Objective: The objective of this meta-analysis was to establish the rates of levator ani muscle (LAM) avulsion in patients after forceps delivery (FD) and vacuum delivery (VD) as assessed by 3D/4D transperineal ultrasound. Methods: A systematic search was performed in the MEDLINE, PubMed, Google Scholar, and Embase databases up to December 31, 2021. Studies that studied primiparous women diagnosed with LAM avulsion by 3D/4D transperineal ultrasound in VD or FD were included. To do the meta-analysis, the jamovi project program version 2.2 (2021) was used. Results: The search yielded 1225 studies that met the MeSH criteria, of which 26 were included in the review. The estimated joint OR for VD vs. normal vaginal delivery (NVD) was 1.93 (95% CI: 1.31–2.86), for FD vs. NVD was 5.33 (95% CI: 3.78–8.11), and for FD vs. VD was 2.36 (95% CI: 1.46–3.84). Conclusions: Instrumented delivery with forceps or vacuum favors LAM avulsion. It is not possible to establish whether this injury is attributable to the specific instrument or to the type of delivery involved in the instrumentation itself.

assisted birth
pelvic floor
Fig. 1.
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