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Is increased peripheral ligamentous laxity in term pregnant women associated with obstetric anal sphincter injury?

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Abstract

Introduction and hypothesis

Increased ligamentous laxity is associated with pelvic floor distension in pregnant women. This considered, it may also be related to the risk of obstetric anal sphincter injury (OASI). Our objective was to assess the association among increased ligamentous laxity, perineal tear severity, and OASI occurrence.

Methods

This is a prospective study. We assessed ligamentous laxity between the 36th week of pregnancy and the onset of labor, by measuring the passive extension of the nondominant index finger for a 0.26 N.m torque applied to the second metacarpophalangeal joint (MCP laxity). We collected perineal tear occurrence and classification (Royal College of Obstetricians and Gynecologists). We investigated the MCP laxity distribution according to the stage of perineal tears, and then we looked for a predictive level of MCP laxity for OASI.

Results

A total of 272 of the 300 pregnant women included had a vaginal delivery and were considered for the analysis. Mean age was 29 years, mean body mass index was 24.5 kg/m2 and 39.2% of women were nulliparous. We reported 12 cases of OASI. MCP laxity significantly increased with the stage of perineal tears from 58° in stage 0 to 69° and 66° for stages 3a and 3b respectively. An MCP laxity higher than 64° was associated with OASI with sensitivity of 75%, specificity of 56%, and an area under the curve of 0.65.

Conclusion

Increased ligamentous laxity seems associated with OASI occurrence, which is the opposite of the initial hypothesis. This suggests that the stiffest tissues might be at a lower risk of injury.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, La Miletrie University Hospital, 2 rue de la Miletrie CS90577, 86021, Poitiers Cedex, France

    Bertrand Gachon, Marion Desgranges, Arnaud Decatoire, Florian Poireault, Fabrice Pierre, Xavier Fritel & David Desseauve

  2. Pprime Institute, RoBioSS Unit, Poitiers University, ENSMA, CNRS UPR 3346, Futuroscope, France

    Laetitia Fradet, Arnaud Decatoire & David Desseauve

  3. INSERM, Center for Research in Epidemiology and Population Health (CESP), U1018, Gender, Sexuality and Health Team, Univ Paris-Sud, UMRS 1018, Villejuif, France

    Xavier Fritel

  4. INSERM CIC-P 1402, La Miletrie University Hospital, Poitiers, France

    Xavier Fritel

Authors
  1. Bertrand Gachon
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  2. Marion Desgranges
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  3. Laetitia Fradet
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  4. Arnaud Decatoire
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  5. Florian Poireault
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  6. Fabrice Pierre
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  7. Xavier Fritel
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  8. David Desseauve
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Corresponding author

Correspondence to Bertrand Gachon.

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Gachon, B., Desgranges, M., Fradet, L. et al. Is increased peripheral ligamentous laxity in term pregnant women associated with obstetric anal sphincter injury?. Int Urogynecol J 29, 1589–1595 (2018). https://doi.org/10.1007/s00192-018-3598-2

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  • DOI: https://doi.org/10.1007/s00192-018-3598-2

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