• José Antonio Sainz, Alicia Martín-Martínez, Enrique González-Diaz, Camino Fernández-Fernández, Ismael Ortega, Margarita Medina, Alfonso Fernández-Corona, Ana Fernández-Palacín, and José Antonio García-Mejido.
• Department of Obstetrics and Gynecology, Valme University Hospital, Seville, Spain.
• Acta Obstet Gynecol Scand. 2019 Nov 1; 98 (11): 1413-1419.

IntroductionForceps use is the main risk factor for levator ani muscle (LAM) injuries. We believe that the disengagement of the forceps branches before delivery of the fetal head could influence LAM injuries, so we aimed to determine the influence of the disengagement of the forceps on the occurrence of LAM avulsion during forceps delivery.Material And MethodsA prospective, observational, multicenter study was conducted with 261 women who underwent forceps delivery. The women were classified according to whether the branches of the forceps had been disengaged before delivery of the fetal head. LAM avulsion was defined using a multislice mode (3 central slices).ResultsIn all, 255 women completed the study (160 without disengagement and 95 with disengagement). LAM avulsions were observed in 37.9% of women in the group with disengagement and in 41.9% of women in the group without disengagement. The crude OR (without disengagement vs with disengagement) for avulsion was 0.90 (95% CI 0.49-1.67, P = 0.757) and an adjusted OR of 0.82 (95% CI 0.40-1.69, P = 0.603).ConclusionsWe did not observe a statistically significant reduction in the LAM avulsion rate with disengagement of the forceps branches before delivery of the fetal head.© 2019 Nordic Federation of Societies of Obstetrics and Gynecology.

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