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Levator ani Avulsion Systematic Evidence Review (LASER)
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  • Zdenek Rusavy,
  • Lenka Paymova,
  • Michal Kozerovsky,
  • Adela Veverkova,
  • Vladimir Kalis,
  • Rasha Kamel,
  • Khaled Ismail
Zdenek Rusavy
Medical Faculty and University Hospital in Pilsen, Charles University in Prague

Corresponding Author:[email protected]

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Lenka Paymova
University Hospital and Charles University
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Michal Kozerovsky
University Hospital and Charles University
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Adela Veverkova
University Hospital and Charles University
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Vladimir Kalis
University Hospital and Charles University
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Rasha Kamel
Cairo University
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Khaled Ismail
Charles University Faculty of Medicine in Pilsen
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Abstract

Background: There is variation in the reported incidence of levator avulsion (LA). Objective: Explore incidence of LA by mode of birth, imaging modality, timing of diagnosis and laterality of avulsion. Search strategy: We searched MEDLINE, EMBASE, CINAHL, AMED and MIDIRS with no language restriction from inception to April 2019. Study eligibility criteria: A study was included if LA was assessed by an imaging modality after the first vaginal birth or if only delivered by caesarean section. Case series and reports were not included. Data collection and analysis: RevMan v5.3 was used for the meta-analyses and SW SAS and STATISTICA packages for type and timing of imaging analyses. . Results: We included 37 primary non-randomized studies from 17 countries and involving 5594 women. Incidence of LA was 1%, 15%, 21%, 38.5% and 52% following caesarean, spontaneous, vacuum, spatula and forceps births respectively, with no differences by imaging modality. OR of LA following spontaneous birth vs. caesarean was 10.69. While the OR for LA following vacuum and forceps compared to the spontaneous birth were 1.66 and 6.32 respectively. LA was more likely to occur on the right side following spontaneous birth (p = 0.02) and unilaterally vs. bilaterally following spontaneous (P < .0001) and vacuum-assisted births (P = 0.0103) only. Incidence was higher if assessment was performed in the first 4 weeks postpartum. Conclusions: Forceps significantly increases incidence and severity of LA. Ultrasound and MRI are comparable diagnostic tools but early postpartum imaging may lead to over diagnosis of LA.
11 Nov 2020Submitted to BJOG: An International Journal of Obstetrics and Gynaecology
12 Nov 2020Submission Checks Completed
12 Nov 2020Assigned to Editor
17 Nov 2020Reviewer(s) Assigned
14 Dec 2020Review(s) Completed, Editorial Evaluation Pending
02 Feb 2021Editorial Decision: Revise Major
22 Feb 20211st Revision Received
24 Feb 2021Submission Checks Completed
24 Feb 2021Assigned to Editor
25 Feb 2021Reviewer(s) Assigned
12 Mar 2021Review(s) Completed, Editorial Evaluation Pending
26 Mar 2021Editorial Decision: Revise Minor
30 Mar 20212nd Revision Received
31 Mar 2021Submission Checks Completed
31 Mar 2021Assigned to Editor
31 Mar 2021Review(s) Completed, Editorial Evaluation Pending
10 Apr 2021Editorial Decision: Accept
Mar 2022Published in BJOG: An International Journal of Obstetrics & Gynaecology volume 129 issue 4 on pages 517-528. 10.1111/1471-0528.16837