ArticleInternational urogynecology journal2026
Levator Ani Muscle Avulsion After Soft Cup Vacuum-Assisted Versus Spontaneous Vaginal Delivery: A 3D Transperineal Ultrasound Study.
Article in International urogynecology journal, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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7 authors.
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Abstract
introduction and hypothesisOperative vaginal delivery is associated with an increased risk of levator ani muscle (LAM) injury. We aimed to compare LAM avulsion and pelvic floor morphology after soft cup vacuum-assisted versus spontaneous vaginal delivery using 3-dimensional transperineal ultrasound (3D-TPUS) and hypothesized that soft cup vacuum-assisted delivery would not increase LAM avulsion rates.
methodsIn this prospective case-control study, nulliparous women who delivered at a tertiary center between January 2023 and December 2025 were included. Women undergoing soft cup-vacuum assisted vaginal delivery were compared with those having spontaneous vaginal delivery. At 6-8 weeks postpartum, participants underwent 3D-TPUS assessment. LAM avulsion, levator-urethra gap (LUG), hiatal dimensions, ballooning, and loss of tenting were evaluated. Functional outcomes were also assessed.
resultsA total of 77 women were analyzed (soft cup n = 36; control n = 41). Complete avulsion was more frequent in the soft cup group (25.0% vs. 9.7%), although this did not reach statistical significance (p = 0.126). Hiatal dimensions, LUG measurements, ballooning, and tenting loss were comparable between groups. Functional outcomes did not differ significantly. Episiotomy rates were higher in the soft cup group (91.7% vs. 53.7%, p < 0.001). Neonatal scalp complications were more frequent following soft vacuum cup-assisted delivery (36.1% vs. 12.2%, p = 0.017), whereas neonatal intensive care unit admissions were similar.
conclusionsSoft cup vacuum-assisted vaginal delivery was not associated with a statistically significant increase in LAM avulsion compared with spontaneous vaginal delivery. Despite higher rates of minor neonatal scalp complications, pelvic floor morphology and functional outcomes were comparable between groups.
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