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Title: Porodna poškodba – avulzija mišice levator ani Authors: ID Vodopivec, Sara (Author) ID Šćepanović, Darija (Author) ID Blaganje, Mija (Author) Files: PDF - Presentation file, download (1,57 MB) MD5: 10EC6C67C78E05A7D8E62C9972B4AC93   URL - Source URL, visit https://vestnik.szd.si/index.php/ZdravVest/article/view/3584/4593   Language: Slovenian Typology: 1.04 - Professional Article Organization: UKC LJ - Ljubljana University Medical Centre Abstract: Ob prvem vaginalnem porodu ženske pride v 10–35 % do avulzije oz. odtrganja dela mišice levator ani (MLA) z njenega narastišča na sramni kosti. Avulzija MLA je pomemben dejavnik tveganja za motnje v delovanju medeničnega dna in za zdrs medeničnih organov. MLA sestavljajo 3 strukturne komponente: m. iliococcygeus, m. pubococcygeus, m. puborectalis. Slednja tvori zanko okrog anorektalnega stika in s tem vzdržuje anorektalni kot. Trikotni prostor, ki ga zanka MLA obdaja, imenujemo levatorjev hiatus, skozi katerega potekajo sečnica, nožnica in anus. Levatorjev hiatus predstavlja največjo potencialno herniacijsko odprtino v telesu. Ob kronanju plodove glavice se morajo medialne vitre MLA raztegniti tudi do trikratne dolžine v mirovanju. Doslej dokazani dejavniki tveganja za avulzijo MLA so: višja starost ob prvem porodu, nižji indeks telesne mase porodnice, porod s forcepsom in z vakuumsko ekstrakcijo, podaljšana druga porodna doba. O vlogi epiziotomije se literatura razhaja. Epiduralna analgezija bi lahko bila zaščitni dejavnik. Klinično lahko avulzijo MLA prepoznamo s palpacijo kontinuitete mišice preko stene nožnice. Diagnostični standard za avulzijo MLA je transperinealni ultrazvočni pregled (UZ). Zgodnje odkrivanje in ukrepanje bi bilo smiselno, da bi izboljšali oskrbo žensk s porodno poškodbo MLA in zmanjšali vpliv le-te na kakovost življenja ženske. Pomembno bi bilo, da bi imele ženske s porodno poškodbo medeničnega dna možnost fizioterapevtske obravnave po porodu. Transperinealni UZ za oceno MLA in analnega sfinktra bi bilo smiselno opraviti pri ženskah po prvem vaginalnem porodu, predvsem v primeru večje poškodbe porodne poti po porodu in v primeru poteka poroda z večjim tveganjem za porodno poškodbo MLA. Keywords: medenično dno, porodna poškodba, zdrs medeničnih organov, pregled, fizioterapija Publication status: Published Publication version: Version of Record Year of publishing: 2025 Number of pages: str. 275-286 Numbering: Letn. 94, št. 9/10 PID: 20.500.12556/DiRROS-24694  UDC: 618.1 ISSN on article: 1318-0347 DOI: 10.6016/ZdravVestn.3584  COBISS.SI-ID: 256513027  Note: Besedilo v slov.; Publication date in DiRROS: 12.12.2025 Views: 56 Downloads: 21 Metadata:    Cite this work Plain text BibTeX EndNote XML EndNote/Refer RIS ABNT ACM Ref AMA APA Chicago 17th Author-Date Harvard IEEE ISO 690 MLA Vancouver : Copy citation

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Record is a part of a journal

Title:	Zdravniški vestnik : glasilo Slovenskega zdravniškega društva
Publisher:	Slovensko zdravniško društvo
ISSN:	1318-0347
COBISS.SI-ID:	32893696

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License:	CC BY-NC 4.0, Creative Commons Attribution-NonCommercial 4.0 International
Link:	http://creativecommons.org/licenses/by-nc/4.0/
Description:	A creative commons license that bans commercial use, but the users don’t have to license their derivative works on the same terms.

Secondary language

Language:	English
Title:	Birth injury – avulsion of the levator ani muscle
Abstract:	During the first vaginal delivery, 10–35% of women experience tearing or avulsion of part of the levator ani muscle (LAM) from its attachment on the pubic bone. LAM avulsion is a significant risk factor for pelvic floor dysfunction and pelvic organ prolapse. LAM consists of three structural components: m. iliococcygeus, m. pubococcygeus, and m. puborectalis. The triangular space surrounded by the LAM is called the levator hiatus and it represents the largest potential hernial portal in the body. During the crowning of the fetal head, the medial fibers of the LAM must stretch up to three times their resting length. Proven risk factors for LAM avulsion include older age at the first birth, lower maternal body mass index, operative delivery with forceps or vacuum extraction, and prolonged second stage of labor. The role of episiotomy is controversial in the literature. Epidural analgesia might be a protective factor. Clinically, LAM avulsion can be recognized by palpation of the muscle continuity through the vaginal wall. The diagnostic standard for LAM avulsion is transperineal ultrasound. Early detection and intervention would be sensible in order to improve the care of women with childbirth-related LAM injuries and reduce the impact on their quality of life. It would be important for women with pelvic floor injury during childbirth to have access to physiotherapeutic treatment postpartum. Transperineal ultrasound to assess LAM and the anal sphincter should be considered for women after their first vaginal delivery, particularly in cases with a higher risk of LAM injury.
Keywords:	pelvic floor, birth injuries, pelvic organ prolapse, transperineal ultrasound, physiotherapy

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