International Urogynecology Journal

, Volume 22, Issue 12, pp 1521–1528 | Cite as

Does the Epi-No® Birth Trainer reduce levator trauma? A randomised controlled trial

  • Ka Lai Shek
  • Varisara Chantarasorn
  • Susanne Langer
  • Hala Phipps
  • Hans Peter Dietz
Original Article

Abstract

Introduction and hypothesis

The purpose of this study is to evaluate whether antepartum use of a birth trainer may reduce levator trauma.

Methods

Two hundred nulliparous women were examined with four-dimensional translabial ultrasonography at 35–37 weeks of gestation and 3 months postpartum in a randomised controlled pilot study. Women in the intervention group were instructed to use the birth trainer from 37 weeks onwards.

Results

One hundred forty-six women returned for follow-up 5.6 months (range 2.3–22.1) after childbirth. Seventy-eight of them had had normal vaginal deliveries (53%), 32 vacuum/forceps (22%) and 36 a caesarean section (25%). The risk of avulsion was halved in the intervention group (6% vs 13%, P = 0.19) on modified intention to treat analysis. A treatment received analysis revealed a nonsignificant 42% and 30% reduction in levator avulsion and microtrauma, respectively (P ≥ 0.22).

Conclusions

This pilot randomised controlled trial showed a nonsignificantly lower incidence of pelvic floor muscle injury in women who used the Epi-No® device from 37 weeks onwards.

Keywords

Childbirth Epi-No birth trainer Levator avulsion Levator microtrauma Pelvic organ prolapse Ultrasound 

References

  1. 1.
    Lien KC, Mooney B, DeLancey JO, Ashton-Miller JA (2004) Levator ani muscle stretch induced by simulated vaginal birth. Obstet Gynecol 103(1):31–40PubMedCrossRefGoogle Scholar
  2. 2.
    Svabik K, Shek KL, Dietz HP (2009) How much does the levator hiatus have to stretch during childbirth? BJOG 116:1657–1662PubMedCrossRefGoogle Scholar
  3. 3.
    Dietz HP, Lanzarone V (2005) Levator trauma after vaginal delivery. Obstet Gynecol 106(4):707–712PubMedCrossRefGoogle Scholar
  4. 4.
    Krofta L, Otcenasek M, Kasikova E, Feyereisl J (2009) Pubococcygeus-puborectalis trauma after forecps delivery: evaluation of the levator ani muscle with 3D/4D ultrasound. Int Urogynecol J 20:1175–1181CrossRefGoogle Scholar
  5. 5.
    Shek KL, Dietz HP (2009) The effect of childbirth on hiatal dimensions. Obstet Gynecol 113(6):1272–1278PubMedGoogle Scholar
  6. 6.
    Toozs-Hobson P, Balmforth J, Cardozo L, Khullar V, Athanasiou S (2008) The effect of mode of delivery on pelvic floor functional anatomy. Int Urogynecol J 19:407–416CrossRefGoogle Scholar
  7. 7.
    Broos SV, Zerba E, Faulkner JA (1995) Injury to muscle fibres after single stretches of passive and maximally stimulated muscles in mice. J Physiol 488(2):459–469Google Scholar
  8. 8.
    Jou I, Lai K, Shen C, Yamano Y (2000) Changes in conduction, blood flow, histology and neurological status following acute nerve-stretch injury induced by femoral lengthening. J Ortho Res 18:149–155CrossRefGoogle Scholar
  9. 9.
    Dietz HP, Shek C, De Leon J, Steensma AB (2008) Ballooning of the levator hiatus. Ultrasound Obstet Gynecol 31(6):676–680PubMedCrossRefGoogle Scholar
  10. 10.
    Dietz HP, Simpson JM (2007) Does delayed child-bearing increase the risk of levator injury in labour? Aust NZ J OG 47(6):491–495Google Scholar
  11. 11.
    DeLancey JOLMD, Morgan DMMD, Fenner DEMD, Kearney RMD, Guire KMS, Miller JMPA et al (2007) Comparison of levator ani muscle defects and function in women with and without pelvic organ prolapse. Obstet Gynecol 109(2, Part 1):295–302PubMedCrossRefGoogle Scholar
  12. 12.
    Adekanmi OA, Freeman R, Puckett M, Jackson S (2005) Cystocele: does anterior repair fail because we fail to correct the fascial defects? A clinical and radiological study. Int Urogynecol J 16:S73CrossRefGoogle Scholar
  13. 13.
    Hillebrenner J, Wagenpfeil S, Schuchardt R, Schelling M, Schneider T (2000) First clinical experiences with the new birth trainer Epi-no® in primiparous women. Z Geburtsh Neonatol 204:1–8CrossRefGoogle Scholar
  14. 14.
    Kovacs G, Heath P, Heather C (2004) First Australian trial of the birth-training device Epi-No: a highly significantly increased chance of an intact perineum. Aust NZ J OG 44:347–348Google Scholar
  15. 15.
    McHugh M, Cosgrave C (2010) To stretch of not to stretch: the role of stretching in injury prevention and performance. Scand J Med Sci Sports 20:169–181PubMedGoogle Scholar
  16. 16.
    Dietz HP (2004) Ultrasound imaging of the pelvic floor. Part II: three-dimensional or volume imaging. Ultrasound Obstet Gynecol 23:615–625PubMedCrossRefGoogle Scholar
  17. 17.
    Dietz HP, Shek C, Clarke B (2005) Biometry of the pubovisceral muscle and levator hiatus by three-dimensional pelvic floor ultrasound. Ultrasound Obstet Gynecol 25(6):580–585PubMedCrossRefGoogle Scholar
  18. 18.
    Yang JM, Yang SH, Huang WC (2006) Biometry of the pubovisceral muscle and levator hiatus in nulliparous Chinese women. Ultrasound Obstet Gynecol 28:710–716PubMedCrossRefGoogle Scholar
  19. 19.
    Kruger JA, Dietz HP, Murphy BA (2007) Pelvic floor function in elite nulliparous athletes. Ultrasound Obstet Gynecol 30(1):81–85PubMedCrossRefGoogle Scholar
  20. 20.
    Shek K, Dietz H (2010) Intrapartum risk factors for levator trauma. BJOG 117:1485–1492PubMedCrossRefGoogle Scholar
  21. 21.
    Dietz HP (2007) Quantification of major morphological abnormalities of the levator ani. Ultrasound Obstet Gynecol 29(3):329–334PubMedCrossRefGoogle Scholar
  22. 22.
    Dietz H, Shek K (2009) Tomographic ultrasound of the pelvic floor: which levels matter most? Ultrasound Obstet Gynecol 33:698–703PubMedCrossRefGoogle Scholar
  23. 23.
    Weinstein MM, Pretorius D, Nager CW, Mittal R (2007) Inter-rater reliability of pelvic floor muscle imaging abnormalities with 3D ultrasound. Ultrasound Obstet Gynecol 30(4):538CrossRefGoogle Scholar
  24. 24.
    Dietz H, Steensma A (2006) The prevalence of major abnormalities of the levator ani in urogynaecological patients. BJOG 113(2):225–230PubMedCrossRefGoogle Scholar
  25. 25.
    Shek K, Dietz H (2010) Can levator avulsion be predicted antenatally? Am J Obstet Gynecol. doi:10.1016/j.ajog.2009.11.038
  26. 26.
    Valsky D, Lipschuetz M, Bord A, Eldar I, Messing B, Hochner-Celnikier D et al (2009) Fetal head circumference and length of second stage of labour are risk factors for levator ani muscle injury, diagnosed by 3-dimensional transperineal ultrasound in primiparous women. Am J Obstet Gynecol 201(91):e1–e7PubMedGoogle Scholar
  27. 27.
    Brooks S, Zebra E, Faulkner J (1995) Injury to the muscle fibres after single stretches of passive and maximally stimulated muscle in mice. J Physio 488(2):459–469Google Scholar
  28. 28.
    Weppler C, Magnusson S (2010) Increasing muscle extensibility: a matter of increasing length or modifying sensation? Phys Ther 90:438–449PubMedCrossRefGoogle Scholar
  29. 29.
    Ingeborg H, Majida M, Engh M, Bo K (2010) Morphological changes after pelvic floor muscle training measured by 3-Dimenisonal ultrasonography. A randomized controlled trial. Obstet Gynecol 115:317–324CrossRefGoogle Scholar
  30. 30.
    King JK, Freeman RM (1998) Is antenatal bladder neck mobility a risk factor for postpartum stress incontinence? BJOG 105(12):1300–1307CrossRefGoogle Scholar

Copyright information

© The International Urogynecological Association 2011

Authors and Affiliations

  • Ka Lai Shek
    • 1
  • Varisara Chantarasorn
    • 1
  • Susanne Langer
    • 1
  • Hala Phipps
    • 2
  • Hans Peter Dietz
    • 1
  1. 1.Nepean Clinical School, Nepean HospitalUniversity of SydneySydneyAustralia
  2. 2.The Royal Prince Alfred Hospital Women and BabiesSydneyAustralia

Personalised recommendations