Kejadian Ballooning dan Avulsi Otot Levator Ani Pada Persalinan Spontan Primipara Non OASIS di Fasilitas Kesehatan Tingkat Pertama

Muhammad Nurhadi Rahman, Mochamad Rizkar Arev Sukarsa, Andi Rinaldi Rinaldi, Eppy Darmadi Achmad, Raden Mas Sonny Sasotya, Edwin Armawan3


Abstract


Pendahuluan: Kerusakan otot levator ani, seperti Ballooning dan Avulsi, sering terjadi pada Obstetric Anal Sphincter Injuries (OASIS) saat persalinan, yang menyebabkan masalah jangka panjang seperti inkontinensia dan prolaps uteri. Namun, hubungan antara kerusakan ini dengan robekan perineum derajat ringan atau Non-OASIS masih kurang dipahami. Penelitian ini bertujuan untuk mengeksplorasi prevalensi Ballooning dan Avulsi pada persalinan spontan primipara Non-OASIS tanpa episiotomi di fasilitas kesehatan tingkat pertama
Metode: Studi cross-sectional dilakukan di Rumah Sakit Umum Pusat Dr. Sardjito Yogyakarta dan praktik mandiri bidan di Sleman, Yogyakarta, melibatkan 69 pasien. Penggunaan USG 3D melalui pendekatan translabial digunakan untuk mengidentifikasi Ballooning dan Avulsi.
Hasil: Dari 69 pasien yang mengalami persalinan spontan primipara Non-OASIS tanpa episiotomi yang terlibat dalam penelitian ini, 66,67% pasien mengalami robekan perineum derajat ringan, sementara 33,3% memiliki perineum intak. Prevalensi Ballooning adalah 26,1% dan Avulsi adalah 17,4%. Ballooning lebih umum terjadi pada pasien dengan robekan perineum derajat ringan (32,6%) daripada yang memiliki perineum intak (13,0%). Avulsi juga lebih sering terjadi pada pasien dengan robekan perineum derajat ringan (21,7%) dibandingkan dengan yang memiliki perineum intak (8,7%).
Kesimpulan: Avulsi terjadi pada satu dari empat persalinan spontan primipara Non-OASIS tanpa episiotomi, sementara Ballooning terjadi pada satu dari enam persalinan. Studi ini memberikan wawasan tentang karakteristik kerusakan otot levator ani dalam setting praktik kebidanan mandiri yang berjejaring dengan fasilitas kesehatan tingkat pertama.

The occurance of Ballooning and Avulsion of The Levator Ani Muscles in First Spontaneous Vaginal Birth Non-OASIS without Episiotomy at Primary Health Facilities

Abstract
Introduction: Damage to the levator ani muscles, such as Ballooning and Avulsion, often occurs during Obstetric Anal Sphincter Injuries (OASIS) during childbirth, leading to long-term issues like incontinence and uterine prolapse. However, the relationship between this damage and mild perineal tears or Non-OASIS is not fully understood. This study aims to explore the prevalence of Ballooning and Avulsion in spontaneous primiparous deliveries without episiotomy in primary healthcare facilities.
Method: A cross-sectional study was conducted at Dr. Sardjito General Hospital in Yogyakarta and midwifery practices in Sleman, Yogyakarta, involving 69 patients. 3D ultrasound via translabial approach was used to identify Ballooning and Avulsion.
Results: Out of 69 patients undergoing spontaneous primiparous deliveries without episiotomy, 66.67% experienced mild perineal tears, while 33.3% had intact perineum. The prevalence of Ballooning was 26.1% and Avulsion was 17.4%. Ballooning was more common in patients with mild perineal tears (32.6%) compared to those with intact perineum (13.0%). Avulsion also occurred more frequently in patients with mild perineal tears (21.7%) compared to those with intact perineum (8.7%).
Conclusion: Avulsion occurs in one out of four spontaneous primiparous deliveries without episiotomy, while Ballooning occurs in one out of six deliveries. This study provides insights into the characteristics of levator ani muscle damage in the setting of primary healthcare facilities connected to independent midwifery practices.

Key words: levator ani muscle avulsion, levator ani muscle ballooning, primipara, mild perineal tear.


Keywords


avulsi otot levator ani, ballooning otot levator ani, primipara, robekan perineum derajat ringan

Full Text:

PDF

References


Guzman Rojas RA, Shek KL, Langer SM, Dietz HP. Prevalence of anal sphincter injury in primiparous women. Ultrasound Obstet Gynecol [Internet]. 2013;42:461–6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23576493

Andrews V, Sultan AH, Thakar R, Jones PW. Occult anal sphincter injuries--myth or reality? BJOG [Internet]. 2006;113:195–200. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16411998

Goh R, Goh D, Ellepola H. Perineal tears-A review. Aust J Gen Pract. 2018;47:35–8.

Waldman R. ACOG Practice Bulletin No. 198: prevention and management of obstetric lacerations at vaginal delivery. Obstet Gynecol. 2019;133:185.

Buppasiri P, Lumbiganon P, Thinkhamrop J, Thinkhamrop B. Antibiotic prophylaxis for third- and fourth-degree perineal tear during vaginal birth. Cochrane Database Syst Rev. 2014/10/08. 2014;Cd005125.

Hsieh WC, Liang CC, Wu D, Chang SD, Chueh HY, Chao AS. Prevalence and contributing factors of severe perineal damage following episiotomy-assisted vaginal delivery. Taiwan J Obstet Gynecol. 2014/12/17. 2014;53:481–5.

Jandér C, Lyrenäs S. Third and fourth degree perineal tears. Predictor factors in a referral hospital. Acta Obstet Gynecol Scand. 2001/02/24. 2001;80:229–34.

Laine K, Gissler M, Pirhonen J. Changing incidence of anal sphincter tears in four Nordic countries through the last decades. Eur J Obstet Gynecol Reprod Biol. 2009/06/02. 2009;146:71–5.

Rizvi RM, Chaudhury N. Practices regarding diagnosis and management of third and fourth degree perineal tears. J Pak Med Assoc. 2008/07/29. 2008;58:244–7.

Samuelsson E, Ladfors L, Wennerholm UB, Gåreberg B, Nyberg K, Hagberg H. Anal sphincter tears: prospective study of obstetric risk factors. BJOG. 2000/07/20. 2000;107:926–31.

Mizrachi Y, Leytes S, Levy M, Hiaev Z, Ginath S, Bar J, et al. Does midwife experience affect the rate of severe perineal tears? Birth. 2017/02/16. 2017;44:161–6.

Sultan AH. Editorial: Obstetrical Perineal Injury and Anal Incontinence. Clin Risk [Internet]. 1999;5:193–6. Available from: https://doi.org/10.1177/135626229900500601

Pangastuti N. Robekan Perineum pada Persalinan Vaginal di Bidan Praktik Swasta (BPS) Daerah Istimewa Yogyakarta Indonesia Tahun 2014-2016. Jurnal Kesehatan Reproduksi. 2016;3:179.

DeLancey JO. The hidden epidemic of pelvic floor dysfunction: achievable goals for improved prevention and treatment. Am J Obstet Gynecol [Internet]. 2005;192:1488–95. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15902147

Dietz HP, Shek C, De Leon J, Steensma AB. Ballooning of the levator hiatus. Ultrasound Obstet Gynecol. 2008;31:676–80.

Dietz HP, Franco A V, Shek KL, Kirby A. Avulsion injury and levator hiatal ballooning: two independent risk factors for prolapse? An observational study. Acta Obstet Gynecol Scand [Internet]. 2012;91:211–4. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22050558

Durnea CM, O’Reilly BA, Khashan AS, Kenny LC, Durnea UA, Smyth MM, et al. Status of the pelvic floor in young primiparous women. Ultrasound Obstet Gynecol [Internet]. 2015;46:356–62. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25359670

Schwertner-Tiepelmann N, Thakar R, Sultan AH, Tunn R. Obstetric levator ani muscle injuries: current status. Ultrasound Obstet Gynecol [Internet]. 2012;39:372–83. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22190408

Shek KL, Dietz HP. Intrapartum risk factors for levator trauma. BJOG [Internet]. 2010;117:1485–92. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20735379

Dietz HP, Shek C. Levator avulsion and grading of pelvic floor muscle strength. Int Urogynecol J. 2008;19:633–6.

Dietz HP, Simpson JM. Does delayed child‐bearing increase the risk of levator injury in labour? Australian and New Zealand Journal of Obstetrics and Gynaecology. 2007;47:491–5.

Kearney R, Miller JM, DeLancey JOL. Interrater reliability and physical examination of the pubovisceral portion of the levator ani muscle, validity comparisons using MR imaging. Neurourology and Urodynamics: Official Journal of the International Continence Society. 2006;25:50–4.

Dickie KJ, Shek KL, Dietz HP. The relationship between urethral mobility and parity. BJOG [Internet]. 2010;117:1220–4. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20618315

Horak TA, Guzman-Rojas RA, Shek KL, Dietz HP. Pelvic floor trauma: does the second baby matter? Ultrasound Obstet Gynecol [Internet]. 2014;44:90–4. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24311466

Shek KL, Green K, Hall J, Guzman-Rojas R, Dietz HP. Perineal and vaginal tears are clinical markers for occult levator ani trauma: a retrospective observational study. Ultrasound Obstet Gynecol [Internet]. 2016;47:224–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25807920

Dietz HP, Lanzarone V. Levator trauma after vaginal delivery. Obstet Gynecol [Internet]. 2005;106:707–12. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16199625

Pineda M, Shek K, Wong V, Dietz HP. Can hiatal ballooning be determined by two‐dimensional translabial ultrasound? Australian and New Zealand Journal of Obstetrics and Gynaecology. 2013;53:489–93.

Khunda A, Shek KL, Dietz HP. Can ballooning of the levator hiatus be determined clinically? Am J Obstet Gynecol [Internet]. 2012;206:246 e1-4. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22133801

Tunestveit JW, Baghestan E, Natvig GK, Eide GE, Nilsen AB V. Factors associated with obstetric anal sphincter injuries in midwife-led birth: A cross sectional study. Midwifery [Internet]. 2018;62:264–72. Available from: http://www.ncbi.nlm.nih.gov/pubmed/29734121

van Delft K, Thakar R, Sultan AH, Schwertner-Tiepelmann N, Kluivers K. Levator ani muscle avulsion during childbirth: a risk prediction model. BJOG [Internet]. 2014;121:1155–63; discussion 1163. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24593314

Zhuang RR, Song YF, Chen ZQ, Ma M, Huang HJ, Chen JH, et al. Levator avulsion using a tomographic ultrasound and magnetic resonance-based model. Am J Obstet Gynecol [Internet]. 2011;205:232 e1-8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21620359

Dietz HP, Moegni F, Shek KL. Diagnosis of levator avulsion injury: a comparison of three methods. Ultrasound Obstet Gynecol [Internet]. 2012;40:693–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22605560

Dietz HP, Hyland G, Hay-Smith J. The assessment of levator trauma: a comparison between palpation and 4D pelvic floor ultrasound. Neurourol Urodyn [Internet]. 2006;25:424–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16721815

Speksnijder L, Oom DMJ, Van Bavel J, Steegers EAP, Steensma AB. Association of levator injury and urogynecological complaints in women after their first vaginal birth with and without mediolateral episiotomy. Am J Obstet Gynecol. 2019;220:93.e1-93.e9.

Speksnijder L, Oom DMJ, Van Bavel J, Steegers EAP, Steensma AB. Association of levator injury and urogynecological complaints in women after their first vaginal birth with and without mediolateral episiotomy. Am J Obstet Gynecol. 2019;220:93.e1-93.e9.

Van de Waarsenburg MK, Verberne EA, van der Vaart CH, Withagen MIJ. Recovery of puborectalis muscle after vaginal delivery: an ultrasound study. Ultrasound in Obstetrics and Gynecology. 2018;52:390–5.

Rahman MN, Wilopo SA, Emilia O. The Efficacy of Divabirth Vaginal Dilator to Prevent Pelvic Floor Trauma During Labor: A Protocol Study. Int J Surg Protoc. 2022;26:88–93.

Kimmich N, Birri J, Richter A, Zimmermann R, Kreft M. Associations of Maternal Complaints to Levator Ani Muscle Trauma within 9 Months after Vaginal Birth: A Prospective Observational Cohort Study. J Pregnancy. 2022;2022.

Dietz HP. Pelvic floor trauma in childbirth. Australian and New Zealand Journal of Obstetrics and Gynaecology. 2013;53:220–30.

Santoso BI. Budi Iman Santoso Assessment (BISA): a model for predicting levator ani injury after vaginal delivery. Medical Journal of Indonesia. 2012;21:102–9.

Santoso BI, Khusen D. Avulsion of the Levator Ani at First Pregnancy Avulsi pada Levator Ani saat Kehamilan Pertama. Majalah Obstetri Ginekologi Indonesia. 2013;37:51–6.

Dietz HP, Abbu A, Shek KL. The levator-urethra gap measurement: A more objective means of determining levator avulsion? Ultrasound in Obstetrics and Gynecology. 2008;32:941–5.

Juniarto ME, Moegni F. Comparison of the Levator Hiatal Area Perbandingan Area Hiatal Levator Ani. 2016.

Wilhelmina K, Van Delft M. Levator ani muscle avulsion following childbirth Assessment and impact on pelvic floor dysfunction. 2014.

Siafarikas F. Levator ani muscle during pregnancy and delivery outcome: A three-and four-dimensional transperineal ultrasound study [Internet]. 2016. Available from: www.07.no




DOI: http://dx.doi.org/10.24198/obgynia.v7i1.639

Refbacks

  • There are currently no refbacks.


Creative Commons License
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.


     
     

Creative Commons License
Indonesian Journal of Obstetrics & Gynecology Science is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License
  Web Analytics
  View My Stat