Journal club MCQ March 2019

Levator ani muscle morphology and function in women with obstetric anal sphincter injury

Learning objectives

Upon completion of this activity, the participant will be better able to:

-Determine initial treatment plans for women with prolapse or incontinence symptoms

-Assess risk factors for major levator ani muscle avulsions in women with obstetric anal sphincter injuries

-Discuss the clinical implications of major levator ani muscle avulsion for a woman with obstetric anal sphincter injury

Question Title

* 1. The recommended first-line treatment for pelvic organ prolapse and incontinence symptoms is…

a. Life style modifications

b. Surgical repair

c. Pelvic floor muscle exercises

d. Medical therapy

Question Title

* 2. The common risk factors of obstetric anal sphincter injury and levator ani muscle avulsion include…

a. Macrosomic infant

b. Primiparity

c. Forceps delivery

d. All of above

Question Title

* 3. According to the study results which of the following factors have an independent association with major levator ani muscle avulsions.

a. Operative delivery

b. Obstetric anal sphincter injury (≥Grade 3c)

c. Episiotomy

d. None of the above

Question Title

* 4. Which of the following statements is true regarding the results of this study:

a. Women with major levator ani muscle avulsion have stronger pelvic muscle strength during both manual and ultrasound examination

b. The difference in pelvic muscle strength between major levator muscle avulsion and control group was smaller for women with bilateral avulsion compared to unilateral avulsion

c. Anal incontinence symptoms as measured with St. Mark score were similar between groups

d. Bilateral major levator ani muscle avulsion was associated with an increased severity of urinary incontinence symptoms