{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T00:39:37Z","timestamp":1747183177321,"version":"3.40.5"},"reference-count":52,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2019,2,22]],"date-time":"2019-02-22T00:00:00Z","timestamp":1550793600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","award":["PI16\/01387"],"award-info":[{"award-number":["PI16\/01387"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2019,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Forceps delivery is associated with a high rate of levator ani muscle (<jats:styled-content style=\"fixed-case\">LAM<\/jats:styled-content>) trauma (avulsion) at 35%\u201065% whereas data on avulsion rates after vacuum delivery vary greatly. Nevertheless, a common characteristic of all previous studies carried out to evaluate the association between instrumental deliveries (forceps and vacuum) and <jats:styled-content style=\"fixed-case\">LAM<\/jats:styled-content> avulsion, is the fact that characteristics of the instrumentation have not been described or evaluated. The objective of this study is to compare the rate of <jats:styled-content style=\"fixed-case\">LAM<\/jats:styled-content> avulsion between forceps and vacuum deliveries according to the characteristics of the instrumentation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and methods<\/jats:title><jats:p>Prospective, observational study, including 263 nulliparous women, who underwent an instrumental delivery with either Malmstr\u00f6m vacuum or Kielland forceps. The characteristics of the instrumentation, position (anterior position and other position) and height of the fetal head at the moment of instrumentation (low instrumentation [vertex at +2 station] and mid\u2010instrumentation [head is involved but leading part above +2 station]) were assessed. Evaluation of <jats:styled-content style=\"fixed-case\">LAM<\/jats:styled-content> avulsion was performed at 6\u00a0months postpartum by three\u2010\/four\u2010dimensional transperineal ultrasound. Using the multi\u2010view mode, a complete avulsion was diagnosed when the abnormal muscle insertion was identified in all three central slices, that is, in the plane of minimal hiatal dimensions and the 2.5\u2010mm and 5.0\u2010mm slices cranial to this one. To detect a 30% or 15% difference in the <jats:styled-content style=\"fixed-case\">LAM<\/jats:styled-content> injury rate, with 80% power and 5% \u03b1\u2010error, we needed, respectively 42 and 99 women per study group.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In all, 263 nulliparous individuals have been evaluated (162 vacuum deliveries, 101 forceps deliveries). Instrumentation in an occipito\u2010anterior position was more frequent in vacuum deliveries (75.3% vs 56.4%, <jats:italic>P\u00a0<\/jats:italic>=\u00a0.002), whereas other positions were more frequent in the forceps deliveries group (24.7% vs 43.6%). No statistically significant differences were noted regarding the height of the fetal head at the moment of instrumentation. No statistically significant differences were found in the presence of <jats:styled-content style=\"fixed-case\">LAM<\/jats:styled-content> avulsion (41.4% vs 38.6%) between vacuum and forceps deliveries. The univariate analysis of the crude odds ratio was 1.17, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.67\u20101.98, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.70 for the avulsion of the <jats:styled-content style=\"fixed-case\">LAM<\/jats:styled-content> and the multivariate of the adjusted <jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 0.90, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>; 0.53\u20101.55, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.71.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>We consider that, in our population, <jats:styled-content style=\"fixed-case\">LAM<\/jats:styled-content> avulsion rate should not be a factor taken into account when choosing the type of instrumentation (Malmstr\u00f6m vacuum or Kielland forceps) in an operative delivery.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.13544","type":"journal-article","created":{"date-parts":[[2019,1,25]],"date-time":"2019-01-25T14:00:07Z","timestamp":1548424807000},"page":"729-736","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["A comparable rate of levator ani muscle injury in operative vaginal delivery (forceps and vacuum) according to the characteristics of the instrumentation"],"prefix":"10.1111","volume":"98","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3079-5583","authenticated-orcid":false,"given":"Jos\u00e9 A.","family":"Garc\u00eda\u2010Mejido","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Valme University Hospital Seville Spain"},{"name":"Department of Obstetrics and Gynecology University of Seville Seville 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