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ABSTRACT
Objective: Levatorani plays an important role in the integrity of the anatomy of pelvic organs. Avulsion of the
levatorani can be caused by vaginal delivery. Genital Hiatus -Perineal Body (GH-PB) complex size can be used
as an indicator of pelvic fascia interference. The purpose of the study is to assess the correlation between the
size of the GH-PB complex with avulsion of the levatorani.
Method: The study design is cross sectional with analytic correlative method of 110 female subjects are
primiparous of 40 days or more post vaginal delivery. Characteristics homogeneity of the subjects test of age
20-35 years old (p=0.150), body mass index 18-30 kg/m2 (p=0.213), birth weight 2500-3500 grams (p=0.413)
with the Mann Whitney test. Inspection is done by measuring the GH-PB complex and 2D translabial
ultrasound in Bandung HasanSadikin Hospital.
Result: Data analysis uses the Mann-Whitney test. Forty subjects with avulsion of the levatorani median size
GH-PB complex is 6 cm and 70 subjects without levatorani avulsion the median size of the GH-PB complex is
5.25 cm (p=0.01).
Conclusion: Complex GH-PB can be used as an indicator of avulsion of the levatorani after vaginal delivery.
Keywords: GH-PB complex, levatorani avulsion, translabial ultrasonography.
Correspondence :Arry Soryadharma. Obstetrics and Gynecology Department, Medical Faculty of Padjadjaran
University/ Hasan Sadikin Hospital Bandung. Phone: 08112008021, Email: arry_soryadharma@hotmail.com.
INTRODUCTION
POP prevalence in the general
population ranges from 5-10%, according
to the 3rd International Consultation on
Incontinence Research (ICI). Women's
Health Intiative (WHI) reported that,
41% of women aged 50-79 years had some
kind of POP around 34% is cystocele,
rectocele as many as 19% and 14% for
uterine prolapse. [1, 2]
Several
epidemiological
studies
reported a population of women who have
POP dominated by white women. Fenner
(2008) stated that white women have twice
the prevalence of POP than black women,
Thom reported that the prevalence of POP
occurred in Hispanic women (36%),
followed by whites(30%), blacks(25% ),
andasian-american race(19%). [3, 4]
POP Incidence increases along with
age, so does the average surgery for
treatment. Weberet al (2006) found the
average age of patients with uterine
prolapse is around 61.5 years and more
than 50% aged 60 years or more. [1, 5] we
have no accurate data in Indonesia, to
reveal the incidence of POP, however, the
annual report from Departement of
Obstetrics and Gynecology Hasan Sadikin
Hospital in 2013 reported there were 45
cases of uterine prolapse from 1,762
gynecologic cases treated. [6]
POP recurrence after surgical correction
is one of the adverse problems in pelvic
reconstruction surgery. Around 30% of all
urinary incontinence and prolapse surgery
performed in the United States is repiring
the recurrence problem. [7, 8] The
primiparous
Women aged 20-35years
Head spontaneous vaginal delivery
More than 40 days postpartum
Infants birth weight 2500-3500 grams
Body Mass Index between 18 and 30
Avulsion
(n= 40)
No avulsi
(n= 70 )
25
16
26
15
0,150
3000
1000
2975
1000
0.213
20,9
12,9
21,8
13,1
0.471
We
Found
no
significant
differences for age range for both groups,
Range
Avulsion
40
6,0
5,0-7,0
Without avulsion
70
5,25
4,0-6,0
0,01*
> 5,5 cm
5,5 cm
Avulsion
21 (52,5 %)
19 (47,5%)
Without avulsion
16 (22,9 %)
54 (77,1%)
0,002*
DISCUSSION
Severalstudies,
including
epidemiological
data,support
the
hypothesis that age is a risk factor for
pelvic organ prolapse with or without
including parity as variables. [31-33]
Studies conducted by Weemhoff, Shek and
Dietz on 375 subjects in which
transperineal ultrasound were performed,
stated that there is a weak correlation
between age of subjects with strength and
pelvic floor muscle morphometry(r =-0.25,
p<0.01). [34] Santoso report on 182
subjects, age ranged from 24 to 27 years is
the highest among all subjects (39,42%),
the mean age of the study subjects was
about 25 years on the levator ani avulsion
group and 27 years in the group without
avulsion of the levator ani, stated that there
was no statistically significant difference
between the two. [35]
Infant birth weight also affect the
incidence of levator ani avulsion. In
research conducted by Santoso,infant
weight over 3325 grams is at risk for
avulsion of the levator ani. Mean weigh
tinfants in the group with avulsion of the
levator ani in this study is 3027 grams
while the levator ani group without
avulsion is 2976 grams. Group with
avulsion of the levator ani with having a
mean birth weight higher than the group
without avulsion of the levator ani. Median
values between the two groups is the same,
CONCLUSION
Avulsion of the levator ani occurred in
36.4% of spontaneous labor. The median
size of the complex GH-PB in spontaneous
labor was 6.0cm. Size GH-PB complexes
with avulsion of the levator ani subjects
are greater than the subjects without
levator ani avulsion. GH-PB complex
sized more than 5.5 cm can be a predictor
of the incidence of levator ani avulsion.
(Sensitivity:52.5%,specificity:
77.1%).
Levator ani avulsion risk for the GH-PB
complex size more than 5.5cm was 2.18
times higher.
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