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Intrapartum Ultrasound and Levator Ani Modifications in Normal and Dystocic Labor

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Intrapartum Ultrasonography for Labor Management

Abstract

The levator ani muscle is the main muscle of the pelvic floor and consists of:

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References

  1. Ashton-Miller JA, DeLancey JO. Functional anatomy of the female pelvic floor. Ann N Y Acad Sci. 2007;1101:266–96.

    PubMed  Google Scholar 

  2. Kearney R, Sawhney R, DeLancey JO. Levator ani muscle anatomy evaluated by origin-insertion pairs. Obstet Gynecol. 2004;104(1):168–73.

    PubMed  PubMed Central  Google Scholar 

  3. Federative Committee on Anatomical Terminology. Terminologia anatomica: international anatomical terminology. Stuttgart: Thieme; 1998.

    Google Scholar 

  4. Kashihara H, Shek KL, Dietz HP. Can we identify the limits of the puborectalis/pubovisceralis muscle on tomographic translabial ultrasound? Ultrasound Obstet Gynecol. 2012;40(2):219–22.

    CAS  PubMed  Google Scholar 

  5. DeLancey JO. Anatomy and biomechanics of genital prolapse. Clin Obstet Gynecol. 1993;36(4):897–909.

    CAS  PubMed  Google Scholar 

  6. DeLancey JO. The anatomy of the pelvic floor. Curr Opin Obstet Gynecol. 1994;6(4):313–6.

    CAS  PubMed  Google Scholar 

  7. Majida M, Braekken IH, Bo K, Benth JS, Engh ME. Validation of three-dimensional perineal ultrasound and magnetic resonance imaging measurements of the pubovisceral muscle at rest. Ultrasound Obstet Gynecol. 2010;35(6):715–22.

    CAS  PubMed  Google Scholar 

  8. Ashton-Miller JA, Delancey JO. On the biomechanics of vaginal birth and common sequelae. Annu Rev Biomed Eng. 2009;11:163–76.

    CAS  PubMed  PubMed Central  Google Scholar 

  9. Ashton-Miller JA, Howard D, DeLancey JO. The functional anatomy of the female pelvic floor and stress continence control system. Scand J Urol Nephrol Suppl. 2001;207:1–7; discussion 106-25

    Google Scholar 

  10. Barber MD, Bremer RE, Thor KB, Dolber PC, Kuehl TJ, Coates KW. Innervation of the female levator ani muscles. Am J Obstet Gynecol. 2002;187(1):64–71.

    PubMed  Google Scholar 

  11. Roshanravan SM, Wieslander CK, Schaffer JI, Corton MM. Neurovascular anatomy of the sacrospinous ligament region in female cadavers: Implications in sacrospinous ligament fixation. Am J Obstet Gynecol. 2007;197(6):660.e1–6.

    Google Scholar 

  12. Guaderrama NM, Liu J, Nager CW, Pretorius DH, Sheean G, Kassab G, et al. Evidence for the innervation of pelvic floor muscles by the pudendal nerve. Obstet Gynecol. 2005;106(4):774–81.

    PubMed  Google Scholar 

  13. Hsu Y, Summers A, Hussain HK, Guire KE, Delancey JO. Levator plate angle in women with pelvic organ prolapse compared to women with normal support using dynamic MR imaging. Am J Obstet Gynecol. 2006;194:1427–33.

    PubMed  PubMed Central  Google Scholar 

  14. Parks AG, Porter NH, Melzak J. Experimental study of the reflex mechanism controlling the muscle of the pelvic floor. Dis Colon Rectum. 1962;5:407–14.

    CAS  PubMed  Google Scholar 

  15. Taverner D, Smiddy FG. An electromyographic study of the normal function of the external anal sphincter and pelvic diaphragm. Dis Colon Rectum. 1959;2(2):153–60.

    CAS  PubMed  Google Scholar 

  16. Orno AK, Dietz HP. Levator co-activation is a significant confounder of pelvic organ descent on Valsalva maneuver. Ultrasound Obstet Gynecol. 2007;30(3):346–50.

    CAS  PubMed  Google Scholar 

  17. Herschorn S. Female pelvic floor anatomy: the pelvic floor, supporting structures, and pelvic organs. Rev Urol. 2004;6(Suppl 5):S2–s10.

    PubMed  PubMed Central  Google Scholar 

  18. Yiou R, Costa P, Haab F, Delmas V. Functional anatomy of the pelvic floor. Prog Urol. 2009;19:916–25. French

    CAS  PubMed  Google Scholar 

  19. Dietz HP, Eldridge A, Grace M, Clarke B. Does pregnancy affect pelvic organ mobility? Aust N Z J Obstet Gynaecol. 2004;44(6):517–20.

    PubMed  Google Scholar 

  20. O’Boyle AL, O’Boyle JD, Ricks RE, Patience TH, Calhoun B, Davis G. The natural history of pelvic organ support in pregnancy. Int Urogynecol J Pelvic Floor Dysfunct. 2003;14(1):46–9; discussion 9

    PubMed  Google Scholar 

  21. O’Boyle AL, O’Boyle JD, Calhoun B, Davis GD. Pelvic organ support in pregnancy and postpartum. Int Urogynecol J Pelvic Floor Dysfunct. 2005;16(1):69–72; discussion

    PubMed  Google Scholar 

  22. Shek KL, Kruger J, Dietz HP. The effect of pregnancy on hiatal dimensions and urethral mobility: an observational study. Int Urogynecol J. 2012;23(11):1561–7.

    PubMed  Google Scholar 

  23. Lowder JL, Debes KM, Moon DK, Howden N, Abramowitch SD, Moalli PA. Biomechanical adaptations of the rat vagina and supportive tissues in pregnancy to accommodate delivery. Obstet Gynecol. 2007;109(1):136–43.

    PubMed  Google Scholar 

  24. Daucher JA, Clark KA, Stolz DB, Meyn LA, Moalli PA. Adaptations of the rat vagina in pregnancy to accommodate delivery. Obstet Gynecol. 2007;109(1):128–35.

    PubMed  Google Scholar 

  25. Feola A, Moalli P, Alperin M, Duerr R, Gandley RE, Abramowitch S. Impact of pregnancy and vaginal delivery on the passive and active mechanics of the rat vagina. Ann Biomed Eng. 2011;39(1):549–58.

    PubMed  Google Scholar 

  26. Harvey MA, Johnston SL, Davies GA. Mid-trimester serum relaxin concentrations and post-partum pelvic floor dysfunction. Acta Obstet Gynecol Scand. 2008;87(12):1315–21.

    PubMed  Google Scholar 

  27. Sangsawang B. Risk factors for the development of stress urinary incontinence during pregnancy in primigravidae: a review of the literature. Eur J Obstet Gynecol Reprod Biol. 2014;178:27–34.

    PubMed  Google Scholar 

  28. Sangsawang B, Sangsawang N. Stress urinary incontinence in pregnant women: a review of prevalence, pathophysiology, and treatment. Int Urogynecol J. 2013;24(6):901–12.

    PubMed  PubMed Central  Google Scholar 

  29. Shek KL, Dietz HP. The effect of childbirth on hiatal dimensions. Obstet Gynecol. 2009;113(6):1272–8.

    PubMed  Google Scholar 

  30. Wijma J, Weis Potters AE, de Wolf BT, Tinga DJ, Aarnoudse JG. Anatomical and functional changes in the lower urinary tract during pregnancy. BJOG. 2001;108(7):726–32.

    CAS  PubMed  Google Scholar 

  31. Villet R, Buzelin JM, Lazorthes F. Female pelvi-perineal disorders. Paris: Vigot; 1995. French

    Google Scholar 

  32. Parente MP, Natal Jorge RM, Mascarenhas T, Fernandes AA, Silva-Filho AL. Computational modeling approach to study the effects of fetal head flexion during vaginal delivery. Am J Obstet Gynecol. 2010;203(3):217 e1–6.

    Google Scholar 

  33. Li X, Kruger JA, Nash MP, Nielsen PM. Anisotropic effects of the levator ani muscle during childbirth. Biomech Model Mechanobiol. 2011;10(4):485–94.

    PubMed  Google Scholar 

  34. Martins JA, Pato MP, Pires EB, Jorge RM, Parente M, Mascarenhas T. Finite element studies of the deformation of the pelvic floor. Ann N Y Acad Sci. 2007;1101:316–34.

    CAS  PubMed  Google Scholar 

  35. Jing D, Ashton-Miller JA, DeLancey JO. A subject-specific anisotropic viscohyperelastic finite element model of female pelvic floor stress and strain during the second stage of labor. J Biomech. 2012;45(3):455–60.

    PubMed  Google Scholar 

  36. Hoyte L, Damaser MS, Warfield SK, Chukkapalli G, Majumdar A, Choi DJ, et al. Quantity and distribution of levator ani stretch during simulated vaginal childbirth. Am J Obstet Gynecol. 2008;199(2):198 e1–5.

    Google Scholar 

  37. Ashton-Miller JA, DeLancey JO. Functional anatomy of the female pelvic floor. Ann N Y Acad Sci. 2007;1101:266–96.

    PubMed  Google Scholar 

  38. Lien KC, Mooney B, DeLancey JO, Ashton-Miller JA. Levator ani muscle stretch induced by simulated vaginal birth. Obstet Gynecol. 2004;103(1):31–40.

    PubMed  PubMed Central  Google Scholar 

  39. Trevathan W. Primate pelvic anatomy and implications for birth. Philos Trans R Soc Lond Ser B Biol Sci. 2015;370(1663):20140065.

    Google Scholar 

  40. Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Rouse DJ, Spong CY, editors. Williams obstetrics. 23rd ed. New York: McGraw-Hill Medical; 2010.

    Google Scholar 

  41. Svabik K, Shek KL, Dietz HP. How much does the levator hiatus have to stretch during childbirth? BJOG. 2009;116(12):1657–62.

    CAS  PubMed  Google Scholar 

  42. DeLancey JO, Kearney R, Chou Q, Speights S, Binno S. The appearance of levator ani muscle abnormalities in magnetic resonance images after vaginal delivery. Obstet Gynecol. 2003;101(1):46–53.

    PubMed  PubMed Central  Google Scholar 

  43. Dietz HP, Lanzarone V. Levator trauma after vaginal delivery. Obstet Gynecol. 2005;106(4):707–12.

    PubMed  Google Scholar 

  44. Tunn R, Paris S, Fischer W, Hamm B, Kuchinke J. Static magnetic resonance imaging of the pelvic floor muscle morphology in women with stress urinary incontinence and pelvic prolapse. Neurourol Urodyn. 1998;17:579–89.

    CAS  PubMed  Google Scholar 

  45. Damaser MS, Whitbeck C, Chichester P, Levin RM. Effect of vaginal distension on blood flow and hypoxia of urogenital organs of the female rat. J Appl Physiol (1985). 2005;98(5):1884–90.

    CAS  Google Scholar 

  46. Damaser MS, Broxton-King C, Ferguson C, Kim FJ, Kerns JM. Functional and neuroanatomical effects of vaginal distention and pudendal nerve crush in the female rat. J Urol. 2003;170(3):1027–31.

    PubMed  Google Scholar 

  47. Chaliha C. Postpartum pelvic floor trauma. Curr Opin Obstet Gynecol. 2009;21(6):474–9.

    PubMed  Google Scholar 

  48. Shek KL, Dietz HP. Intrapartum risk factors for levator trauma. BJOG. 2010;117(12):1485–92.

    CAS  PubMed  Google Scholar 

  49. Dietz HP. Pelvic floor trauma in childbirth. Aust N Z J Obstet Gynaecol. 2013;53(3):220–30.

    PubMed  Google Scholar 

  50. Valsky DV, Lipschuetz M, Bord A, Eldar I, Messing B, Hochner-Celnikier D, et al. Fetal head circumference and length of second stage of labor are risk factors for levator ani muscle injury, diagnosed by 3-dimensional transperineal ultrasound in primiparous women. Am J Obstet Gynecol. 2009;201(1):91 e1–7.

    PubMed  Google Scholar 

  51. Dietz HP, Shek KL. Tomographic ultrasound imaging of the pelvic floor: which levels matter most? Ultrasound Obstet Gynecol. 2009;33(6):698–703.

    CAS  PubMed  Google Scholar 

  52. Kearney R, Miller JM, Ashton-Miller JA, DeLancey JO. Obstetric factors associated with levator ani muscle injury after vaginal birth. Obstet Gynecol. 2006;107(1):144–9.

    PubMed  PubMed Central  Google Scholar 

  53. Dietz HP, Simpson JM. Does delayed child-bearing increase the risk of levator injury in labour? Aust N Z J Obstet Gynaecol. 2007;47(6):491–5.

    PubMed  Google Scholar 

  54. South MM, Stinnett SS, Sanders DB, Weidner AC. Levator ani denervation and reinnervation 6 months after childbirth. Am J Obstet Gynecol. 2009;200(5):519.e1–7.

    Google Scholar 

  55. Handa VL, Danielsen BH, Gilbert WM. Obstetric anal sphincter lacerations. Obstet Gynecol. 2001;98(2):225–30.

    CAS  PubMed  Google Scholar 

  56. Snooks SJ, Swash M, Henry MM, Setchell M. Risk factors in childbirth causing damage to the pelvic floor innervation. Int J Color Dis. 1986;1(1):20–4.

    CAS  Google Scholar 

  57. Snooks SJ, Setchell M, Swash M, Henry MM. Injury to innervation of pelvic floor sphincter musculature in childbirth. Lancet. 1984;2(8402):546–50.

    CAS  PubMed  Google Scholar 

  58. Donnelly V, Fynes M, Campbell D, Johnson H, O’Connell PR, O’Herlihy C. Obstetric events leading to anal sphincter damage. Obstet Gynecol. 1998;92(6):955–61.

    CAS  PubMed  Google Scholar 

  59. García-Mejido JA, Gutierrez L, Fernández-Palacin A, Aquise A, Sainz JA. Levator ani muscle injures associated with vaginal vacuum assisted delivery determined by 3/4D transperineal ultrasound. J Matern Fetal Neonatal Med. 2016;21:1–6.

    Google Scholar 

  60. Kruger JA, Heap SW, Murphy BA, Dietz HP. Pelvic floor function in nulliparous women using three-dimensional ultrasound and magnetic resonance imaging. Obstet Gynecol. 2008;111(3):631–8.

    CAS  PubMed  Google Scholar 

  61. Dietz HP, Shek KL, Clarke B. Biometry of the puborectalis muscle and levator hiatus by 3D pelvic floor ultrasound. Ultrasound Obstet Gynecol. 2005;25:580–5.

    CAS  PubMed  Google Scholar 

  62. Dietz HP, Wilson PD. Childbirth and pelvic floor trauma. Best Pract Res Clin Obstet Gynaecol. 2005;19:913–24.

    CAS  PubMed  Google Scholar 

  63. De Leon J, Steensma A, Shek KL, Dietz HP. Ballooning: how to define abnormal distensibility of the levator hiatus. Ultrasound Obstet Gynecol. 2007;30:367–455.

    Google Scholar 

  64. Dietz HP. Ultrasound imaging of the pelvic floor. Part II: three-dimensional or volume imaging. Ultrasound Obstet Gynecol. 2004;23(6):615–25.

    CAS  PubMed  Google Scholar 

  65. Santoro GA, Wieczorek AP, Dietz HP, Mellgren A, Sultan AH, Shobeiri SA, et al. State of the art: an integrated approach to pelvic floor ultrasonography. Ultrasound Obstet Gynecol. 2011;37(4):381–96.

    CAS  PubMed  Google Scholar 

  66. Dietz HP. Pelvic floor ultrasound: a review. Am J Obstet Gynecol. 2010;202(4):321–34.

    PubMed  Google Scholar 

  67. Kamel R, Montaguti E, Nicolaides KH, et al. Contraction of the levator ani muscle during Valsalva maneuver (coactivation) is associated with a longer active second stage of labor in nulliparous women undergoing induction of labor. Am J Obstet Gynecol. 2019;220:189.e1–8.

    Google Scholar 

  68. Dietz HP. Pelvic floor ultrasound in prolapse: what’s in it for the surgeon? Int Urogynecol J. 2011;22(10):1221–32.

    PubMed  Google Scholar 

  69. Dietz HP, Hoyte L, Steensma AB. Atlas of pelvic floor ultrasound. Dordrecht: Springer; 2008.

    Google Scholar 

  70. Dietz HP, Bernardo MJ, Kirby A, Shek KL. Minimal criteria for the diagnosis of avulsion of the puborectalis muscle by tomographic ultrasound. Int Urogynecol J. 2011;22(6):699–704.

    PubMed  Google Scholar 

  71. Blasi I, Fuchs I, D’Amico R, Vinci V, La Sala GB, Mazza V, et al. Intrapartum translabial three- dimensional ultrasound visualization of levator trauma. Ultrasound Obstet Gynecol. 2011;37:88–92.

    CAS  PubMed  Google Scholar 

  72. Fuchs I, Tutschek B, Henrich W. Visualization of the fetal fontanels and skull sutures by three-dimensional translabial ultrasound during the second stage of labor. Ultrasound Obstet Gynecol. 2008;31:484–6.

    CAS  PubMed  Google Scholar 

  73. García Mejido JA, Suárez Serrano CM, Fernéndez Palacín A, Aquise Pino A, Bonomi Barby MJ, Sainz Bueno JA. Evaluation of levator ani muscle throughout the different stages of labor by transperineal 3D ultrasound. Neurourol Urodyn. 2017;36:1776–81.

    PubMed  Google Scholar 

  74. Cleary-Goldman J, Robinson JN. The role of episiotomy in current obstetric practice. Semin Perinatol. 2003;27(1):3–12.

    PubMed  Google Scholar 

  75. Lede RL, Belizan JM, Carroli G. Is routine use of episiotomy justified? Am J Obstet Gynecol. 1996;174(5):1399–402.

    CAS  PubMed  Google Scholar 

  76. Donald I. Practical obstetric problems. London: Lloyd-Luke; 1979.

    Google Scholar 

  77. Flood C. The real reason for performing episiotomies. World Med. 1982;17:51.

    Google Scholar 

  78. Greenshields W, Ulme HH. The perineum in childbirth: a survey of women’s experiences and midwifery practices. London: National Childbirth Trust; 1993.

    Google Scholar 

  79. Kitzinger S, Walters R. Some women’s experience of episiotomy. London: National Childbirth Trust; 1981.

    Google Scholar 

  80. Carroli G, Belizan J. Episiotomy for vaginal birth. Cochrane Database Syst Rev. 2000;1:CD000081.

    Google Scholar 

  81. Espuna-Pons M, Solans-Domenech M, Sanchez E, On Behalf of the Pelvic Floor Research Group (GRESP). Double incontinence in a cohort of nulliparous pregnant women. Neurourol Urodyn. 2012;31:1236–41.

    PubMed  Google Scholar 

  82. Dietz HP, Shek KL, Chantarasorn V, et al. Do women notice the effect of childbirth-related pelvic floor trauma? Aust N Z J Obstet Gynaecol. 2012;52:277–81.

    PubMed  Google Scholar 

  83. Handa VL, Blomquist JL, McDermott KC, et al. Pelvic floor disorders after vaginal birth: effect of episiotomy, perineal laceration, and operative birth. Obstet Gynecol. 2012;119:233–9.

    PubMed  PubMed Central  Google Scholar 

  84. Bø K, Hilde G, Tennfjord MK, Engh ME. Does episiotomy influence vaginal resting pressure, pelvic floor muscle strength and endurance, and prevalence of urinary incontinence 6 weeks postpartum? Neurourol Urodyn. 2017;36:716–21.

    PubMed  Google Scholar 

  85. Cam C, Asoglu MR, Selcuk S, et al. Does mediolateral episiotomy decrease central defects of the anterior vaginal wall? Arch Gynecol Obstet. 2012;285:411–5.

    PubMed  Google Scholar 

  86. Cassado J, et al. Does episiotomy protect against injury of the levator ani muscle in normal vaginal delivery? Neurourol Urodyn. 2014;33:1212–6.

    PubMed  Google Scholar 

  87. Fitzgerald MP, Weber AM, Howden N, Cundiff GW, Brown MB. Risk factors for anal sphincter tear during vaginal delivery. Obstet Gynecol. 2007;109(1):29–34.

    PubMed  Google Scholar 

  88. Dandolu V, Chatwani A, Harmanli O, Floro C, Gaughan JP, Hernandez E. Risk factors for obstetrical anal sphincter lacerations. Int Urogynecol J Pelvic Floor Dysfunct. 2005;16(4):304–7.

    PubMed  Google Scholar 

  89. Coats PM, Chan KK, Wilkins M, Beard RJ. A comparison between midline and mediolateral episiotomies. Br J Obstet Gynaecol. 1980;87(5):408–12.

    CAS  PubMed  Google Scholar 

  90. Shiono P, Klebanoff MA, Carey JC. Midline episiotomies: more harm than good? Obstet Gynecol. 1990;75(5):765–70.

    CAS  PubMed  Google Scholar 

  91. Revicky V, Nirmal D, Mukhopadhyay S, Morris EP, Nieto JJ. Could a mediolateral episiotomy prevent obstetric anal sphincter injury? Eur J Obstet Gynecol Reprod Biol. 2010;150(2):142–6.

    PubMed  Google Scholar 

  92. Andrews V, Sultan AH, Thakar R, Jones PW. Risk factors for obstetric anal sphincter injury: a prospective study. Birth. 2006;33(2):117–22.

    PubMed  Google Scholar 

  93. Sheiner E, Levy A, Walfisch A, Hallak M, Mazor M. Third degree perineal tears in a university medical center where midline episiotomies are not performed. Arch Gynecol Obstet. 2005;271(4):307–10.

    PubMed  Google Scholar 

  94. de Leeuw JW, de Wit C, Kuijken JP, Bruinse HW. Mediolateral episiotomy reduces the risk for anal sphincter injury during operative vaginal delivery. BJOG. 2008;115(1):104–8.

    PubMed  Google Scholar 

  95. Kalis V, Landsmanova J, Bednarova B, Karbanova J, Laine K, Rokyta Z. Evaluation of the incision angle of mediolateral episiotomy at 60 degrees. Int J Gynaecol Obstet. 2011;112(3):220–4.

    PubMed  Google Scholar 

  96. Eogan M, Daly L, O’Connell PR, O’Herlihy C. Does the angle of episiotomy affect the incidence of anal sphincter injury? BJOG. 2006;113(2):190–4.

    CAS  PubMed  Google Scholar 

  97. Aytan H, Tapisiz OL, Tuncay G, Avsar FA. Severe perineal lacerations in nulliparous women and episiotomy type. Eur J Obstet Gynecol Reprod Biol. 2005;121(1):46–50.

    PubMed  Google Scholar 

  98. Aytan H, Tok EC, Ertunc D, Yasa O. The effect of episiotomy on pelvic organ prolapse assessed by pelvic organ prolapse quantification system. Eur J Obstet Gynecol Reprod Biol. 2014;173:34–7.

    PubMed  Google Scholar 

  99. Beatty TE. Contributions to medicine and midwifery. Dublin: Fannin and Co; 1866. p. 567.

    Google Scholar 

  100. Black JW. Selected obstetrical & gynaecological works of Sir James Y. Simpson, Bart. Edinburgh: Adam and Charles Black; 1871. p. 65.

    Google Scholar 

  101. Fleming N. Comparison of women with different perineal conditions after childbirth. Ann Arbor: UMI; 1987.

    Google Scholar 

  102. Fleming N. Can the suturing method make a difference in postpartum perineal pain? J Nurse-Midwifery. 1990;35(1):19–25.

    CAS  PubMed  Google Scholar 

  103. Floud E. Protecting the perineum in childbirth 1: a retrospective view. Br J Midwifery. 1994;2(6):258–63.

    Google Scholar 

  104. Verheijen EC, Raven JH, Hofmeyr GJ. Fundal pressure during the second stage of labor. Cochrane Database Syst Rev. 2009;4:CD006067. https://doi.org/10.1002/14651858.CD006067.pub2.

    Article  Google Scholar 

  105. Kline-Kaye V, Miller-Slade D. The use of fundal pressure during the second stage of labor. J Obstet Gynecol Neonatal Nurs. 1990;19(6):511–7. https://doi.org/10.1111/j.1552-6909.1990.tb01670.x.

    Article  CAS  PubMed  Google Scholar 

  106. Merhi ZO, Awonuga AO. The role of uterine fundal pressure in the management of the second stage of labor: a reappraisal. Obstet Gynecol Surv. 2005;60:599–603. https://doi.org/10.1097/01.ogx.0000175804.68946.ac.

    Article  PubMed  Google Scholar 

  107. Matsuo K, Shiki Y, Yamasaki M, Shimoya K. Use of uterine fundal pressure maneuver at vaginal delivery and risk of severe perineal laceration. Arch Gynecol Obstet. 2009;280:781.

    PubMed  Google Scholar 

  108. Api O, Balcin ME, Ugurel V, Api M, Turan C, Unal O. The effect of uterine fundal pressure on the duration of the second stage of labor: a randomized controlled trial. Acta Obstet Gynecol Scand. 2009;88(3):320–4. https://doi.org/10.1080/00016340902730326.

    Article  PubMed  Google Scholar 

  109. Sartore A, et al. The effects of uterine fundal pressure (Kristeller maneuver) on pelvic floor function after vaginal delivery. Arch Gynecol Obstet. 2012;286(5):1135–9.

    PubMed  Google Scholar 

  110. Cosner KR. Use of fundal pressure during second stage of labor. A pilot study. J Nurse Midwifery. 1996;41(4):334–7.

    CAS  PubMed  Google Scholar 

  111. Zetterstrom J, Lopez A, Anzen B, Norman M, Holmstrom B, Mellgren A. Anal sphincter tears at vaginal delivery: risk factors and clinical outcome of primary repair. Obstet Gynecol. 1999;94(1):21–8.

    CAS  PubMed  Google Scholar 

  112. de Tayrac R, et al. Anatomy and physiology of the pelvic floor. In: Ismail K, editor. Perineal trauma at childbirth. Cham: Springer; 2016.

    Google Scholar 

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Cairo University Hospitals, Cairo, Egypt

    Rasha Kamel

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  1. Rasha Kamel
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  1. Department of Obstetric and Gynecology, Santa Maria Hospital, GVM Care and Research, Bari, Italy

    Antonio Malvasi

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Kamel, R. (2021). Intrapartum Ultrasound and Levator Ani Modifications in Normal and Dystocic Labor. In: Malvasi, A. (eds) Intrapartum Ultrasonography for Labor Management. Springer, Cham. https://doi.org/10.1007/978-3-030-57595-3_35

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