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"Latar belakang: Prolaps organ panggul (POP) didefinisikan sebagai turunnya visera pelvis (uterus, kandung kemih, uretra, dan rektum) dari posisi normal. Otot levator ani merupakan penopang panggul yang berperan penting dalam patogenesis POP. Studi sebelumnya menunjukkan terdapat perbedaan luas area hiatus dan panjang anteroposterior hiatus levator ani pada setiap derajat keparahan POP. Diagnosis POP dapat ditegakkan dengan POP-Q, namun pelaksanannya masih terbatas sehingga dibutuhkan alat pemeriksaan lain untuk skrining pasien. Metode: Penelitian ini adalah penelitian potong lintang dengan metode consecutive sampling. Peneliti mengidentifikasi subjek POP dengan dan tanpa keluhan benjolan. Subjek yang bersedia ikut serta dalam penelitian ini menjalani pemeriksaan POP-Q, panjang genital hiatus (Gh) dan perineal body (Pb), dan pemeriksaan USG translabial 3D/4D. Data dianalisis menggunakan SPSS Statistics 20 dengan uji T tidak berpasangan untuk membandingkan rerata parameter luas area hiatus dan panjang anteroposterior levator ani. Selanjutnya dilakukan analisa ROC untuk mendapatkan nilai titik potong dengan estimasi sensitifitas dan spesifisitas terbaik untuk membedakan prolaps bergejala dan tidak bergejala benjolan. Hasil: Sebanyak 109 subjek ikut serta dalam penelitian ini. Terdapat perbedaan bermakna luas hiatus (28,9+5,59 vs 19,6+4,63, p < 0,05 saat valsalva, 15,2+4,08 vs 12,5+3,15, p <0,005 saat kontraksi) dan panjang anteroposterior levator ani (8,6+1,06 vs 6,8+1.13, p<0,05) antara kelompok dengan keluhan benjolan dan kelompok tanpa keluhan benjolan. Titik potong luas area hiatus dan panjang anteroposterior levator ani untuk membedakan subjek dengan keluhan benjolan dan tanpa keluhan benjolan adalah 25,1 cm2 [sensitifitas 84,6%, spesifisitas 92,9%, AUC 0,925 (0,864-0,986)] dan 7,75 cm [sensitifitas 87,2%, spesifisitas 77,1%, AUC 0,859 (0,787-0,932)].Kesimpulan: Terdapat perbedaan bermakna luas hiatus dan panjang anteroposterior levator ani antara kelompok dengan keluhan benjolan dan tanpa keluhan benjolan. Titik potong luas hiatus 25,1 cm dan panjang anteroposterior 7,75 cm memiliki sensitifitas dan spesifisitas yang baik untuk membedakan kedua kelompok.

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Introduction: Pelvic organ prolapse (POP) is defined as descent of the pelvic viscera (uterus, bladder, urethra, and rectum) from its normal position. Levator ani muscle is the largest component of pelvic floor that plays an important part in POP pathogenesis. Previous study showed that there was difference in levator hiatus area and anteroposterior length on every grade of POP. The diagnosis of POP can be established from POP-Q tool, however its use is still very limited within its subspecialist practice causing the need of a new screening tool.

Methods: This was a cross-sectional study with consecutive sampling method. We classified POP subject with bulge symptom and without bulge symptom. Subjects that were willing to participate in this study under underwent POP-Q examination and 3D/4D transperineal ultrasonography. Data were analyzed using SPSS Statistics 20 with student’s t-test to compare levator hiatus area and anteroposterior length mean between 2 group.

Results: A total of 109 subjects were included in this study. There was a significance difference in levator hiatus area (28.9+5.59 cm2 vs 19.6+4.63 cm2, p < 0/05 during valsalva maneuver, 15.2+4.08 cm2 vs 12.5+3.15 cm2, p <0.05 during contraction) and anteroposterior length (8.6+1.06 c, vs 6.8+1.13 cm, p<0,05) between group with bulge symptom and without bulge symptom. Levator hiatus area and anteroposterior length cutoff to differentiate between subject with and without bulge symtoms was respectively 25,1 cm2 [sensitivity 84,6%, specificity 92,9%, AUC 0,925 (0,864-0,986)] and 7,75 cm [sensitivity 87,2%, specificity 77,1%, AUC 0,859 (0,787-0,932)].

Conclusion: There was a significant difference in levator hiatus area and anteroposterior length between group with and without bulge symptom. Levator hiatus area cut off at 25,1 cm2 anteroposterior length cut off at 7.75 cm showed good sensitivity and specificity to differentiate between 2 group."

"Latar Belakang: Prolaps organ panggul merupakan perubahan anatomi dimana terjadi penurunan bagian atau organ panggul dan banyak diakibatkan oleh faktor persalinan pervaginam. Ballooning dan avulsi levator ani merupakan faktor risiko independen terjadinya prolaps organ panggul sehingga risiko terjadinya prolaps organ panggul meningkat. Hingga saat ini, belum ada penelitian mengenai angka kejadian dan faktor risiko terhadap ballooning hiatus levator ani pada primipara partus pervaginam di Indonesia. Metode: Penelitian ini menggunakan desain kasus kontrol bersarang yang dilakukan terhadap 71 perempuan primipara pasca persalinan pervaginam di RS Budi Kemuliaan Jakarta dan Klinik Tiara Bunda Bekasi pada periode Februari hingga Desember 2024. Data diperoleh secara prospektif melalui penilaian ballooning hiatus levator ani dan avulsi pada 40 hari dan 3-6 bulan pasca persalinan menggunakan USG dasar panggul. Faktor risiko yakni, usia ibu, IMT ibu saat persalinan, penggunaan alat pada saat persalinan, lama kala II, berat badan lahir bayi, ukuran lingkar kepala bayi, OASIS, dan episiotomi, diperoleh dari data sekunder. Luaran yang dievaluasi adalah ballooning hiatus levator ani pasca persalinan.Hasil: Sebanyak 71 subjek penelitian dianalisis dan dibagi menjadi 2 kelompok, yaitu kelompok studi (ballooning hiatus levator ani) sebanyak 33 subjek dan kelompok kontrol (non-ballooning hiatus levator ani) sebanyak 38 subjek. Dari hasil penelitian didapatkan angka kejadian ballooning hiatus levator ani pada 40 hari pasca persalinan adalah 46,5% dan 3-6 bulan pasca persalinan adalah 14,1%. Terdapat 30,3% subjek dengan ballooning hiatus levator ani yang menetap hingga 3–6 bulan pasca persalinan. Terdapat 3 faktor risiko yang bermakna secara statistik dan klinis yakni, usia ibu (OR 2,64, 95% CI 1,01–6,89; p=0,046), IMT ibu (OR 3,84, 95% CI 1,43–10,31; p=0,006), dan berat badan lahir bayi (OR 6,55, 95% CI 2,43–18,49; p=0,000). Titik potong faktor risiko usia ibu, IMT ibu, berat badan lahir bayi, dan lingkar kepala bayi berturut-turut adalah 28,5 tahun (sensitivitas 60,6% spesifisitas 63,3%), 25,6 kg/m2 (sensitivitas 66,7% spesifisitas 65,8%), 3192,5 gram (sensitivitas 72,7% spesifisitas 71,1%), dan 33,74 cm (sensitivitas 78,8% spesifisitas 50%). Kesimpulan: Faktor risiko yang berhubungan dengan kejadian ballooning hiatus levator ani pasca persalinan adalah usia ibu, IMT ibu saat persalinan, dan berat badan lahir bayi. 

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Background: Pelvic organ prolapse (POP) refers to an anatomical alteration in which there is descent of one or more pelvic organs, often caused by vaginal delivery. Ballooning and avulsion of the levator ani muscles are independent risk factors for the development of pelvic organ prolapse, thereby increasing the likelihood of its occurrence. Until today, there is no research on the incidence of pelvic organ prolapse in Indonesia, and associated risk factors for levator hiatal ballooning in primiparous women following vaginal delivery.

Methods: This study employs a nested case-control design conducted on 71 primiparous women following vaginal delivery at Budi Kemuliaan Hospital, Jakarta and Tiara Bunda Clinic, Bekasi, from February to December 2024. Translabial ultrasound was performed to assess the presence of levator hiatal ballooning and avulsion at 40 days and 3–6 months after delivery. Risk factors, including maternal age, postpartum body mass index (BMI), use of assisted delivery techniques, duration of the second stage of labor, birth weight, head circumference, OASIS (Obstetric Anal Sphincter Injuries), and episiotomy, were obtained from secondary data. The primary outcome evaluated was levator hiatal ballooning after delivery.

Results: A total of 71 research subjects were analyzed and divided into two groups: the study group (ballooning hiatus levator ani) consisting of 33 subjects and the control group (non-ballooning hiatus levator ani) consisting of 38 subjects. The results showed that the incidence of ballooning hiatus levator ani was 46.5% at 40 days postpartum and 14.1% at 3-6 months postpartum. Furthermore, 30.3% of subjects with ballooning hiatus levator ani showed persistence of the condition up to 3–6 months postpartum. Five statistically and clinically significant risk factors were identified: maternal age (OR 2.64, 95% CI 1.01–6.89; p=0.046), maternal BMI (OR 3.84, 95% CI 1.43–10.31; p=0.006), infant birth weight (OR 6.55, 95% CI 2.43–18.49; p<0.001). The cutoff points for the risk factors—maternal age, maternal BMI, and infant birth weight—were found to be 28.5 years (sensitivity 60.6%, specificity 63.3%), 25.6 kg/m² (sensitivity 66.7%, specificity 65.8%), and 3192.5 grams (sensitivity 72.7%, specificity 71.1%).

Conclusion: The risk factors associated with the occurrence of levator hiatal ballooning post-delivery are maternal age, maternal BMI during pregnancy, and infant birth weight. "