{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T09:33:41Z","timestamp":1784626421229,"version":"3.55.0"},"reference-count":23,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2016,1,13]],"date-time":"2016-01-13T00:00:00Z","timestamp":1452643200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Part of the study data was obtained in an original study funded by the Betty Byrne Henderson Foundation, Brisbane, Qld, Australia"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp; Gyne"],"published-print":{"date-parts":[[2016,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Levator avulsion has been shown to be associated with anterior and central compartment prolapse and is a risk factor for prolapse recurrence. Diagnosis in the delivery room is usually impossible, as levator avulsion is commonly occult. The objective of this study was to determine if vaginal and major perineal tears are clinical markers of levator trauma as diagnosed by four\u2010dimensional (<jats:styled-content style=\"fixed-case\">4D<\/jats:styled-content>) translabial ultrasound 3\u20136 months postpartum.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a retrospective observational study using data obtained in two perinatal trials. A total of 774 women seen, on average, 5 (range, 2.3\u201322.4) months after their first delivery of a term singleton cephalic baby underwent a standardized interview, clinical assessment and <jats:styled-content style=\"fixed-case\">4D<\/jats:styled-content> translabial ultrasound examination. Clinical data were obtained from the institutional obstetric database, including information on vaginal and perineal tears. Levator avulsion was diagnosed using tomographic ultrasound, with operators blinded to the clinical data.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Both third\u2010 and fourth\u2010degree perineal tears and vaginal sidewall tears were independently associated with levator avulsion (<jats:italic>P<\/jats:italic> = 0.004 and <jats:italic>P<\/jats:italic> = 0.012, respectively). The odds ratio for avulsion in women suffering from such overt trauma was 3.44 (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>, 1.47\u20138.03) for third\u2010\/fourth\u2010degree perineal tears and 3.35 (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>, 1.30\u20138.61) for vaginal sidewall tears.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Vaginal sidewall and third\u2010\/fourth\u2010degree perineal tears were found to be independent clinical indicators of an increased risk of levator trauma, as diagnosed by <jats:styled-content style=\"fixed-case\">4D<\/jats:styled-content> translabial ultrasound 3\u20136 months postpartum. Such clinical markers may become useful in the identification of women at high risk of levator trauma and future pelvic floor disorders. Copyright \u00a9 2015 ISUOG. Published by John Wiley &amp; Sons Ltd.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.14856","type":"journal-article","created":{"date-parts":[[2015,3,25]],"date-time":"2015-03-25T09:18:53Z","timestamp":1427275133000},"page":"224-227","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":54,"title":["Perineal and vaginal tears are clinical markers for occult levator ani trauma: a retrospective observational study"],"prefix":"10.1002","volume":"47","author":[{"given":"K. L.","family":"Shek","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Liverpool Clinical School Western Sydney University  Sydney Australia"},{"name":"Department of Obstetrics and Gynaecology, Nepean Clinical School University of Sydney  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K.","family":"Green","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Nepean Clinical School University of Sydney  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Hall","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Nepean Clinical School University of Sydney  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Guzman\u2010Rojas","sequence":"additional","affiliation":[{"name":"Departamento de Ginecolog\u00eda y Obstetricia Cl\u00ednica Alemana de Santiago  Santiago Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H. P.","family":"Dietz","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Nepean Clinical School University of Sydney  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2016,1,13]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e3182267f2f"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000178779.62181.01"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2008.01751.x"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-014-2388-8"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0412.2011.01315.x"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajo.12171"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijgo.2011.02.020"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-011-1524-y"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000194063.63206.1c"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000000825"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2010.02704.x"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijgo.2010.05.019"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2010.01.002"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-010-1329-4"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000242616.56617.ff"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.12274"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.13252"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2009.03.028"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000250901.57095.ba"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0412.2011.01315.x"},{"key":"e_1_2_6_22_1","first-page":"852","article-title":"A multicentre randomised controlled trial of a pelvic floor muscle training intervention for the prevention of pelvic organ prolapse (PREVPROL)","volume":"33","author":"Hagen S","year":"2014","journal-title":"Neurourol Urodyn"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajo.12059"},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.12481"}],"container-title":["Ultrasound in Obstetrics &amp; Gynecology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fuog.14856","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/uog.14856","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,31]],"date-time":"2025-01-31T17:42:58Z","timestamp":1738345378000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1002\/uog.14856"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,1,13]]},"references-count":23,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2016,2]]}},"alternative-id":["10.1002\/uog.14856"],"URL":"https:\/\/doi.org\/10.1002\/uog.14856","archive":["Portico"],"relation":{},"ISSN":["0960-7692","1469-0705"],"issn-type":[{"value":"0960-7692","type":"print"},{"value":"1469-0705","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,1,13]]},"assertion":[{"value":"2014-11-10","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2015-03-20","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2016-01-13","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}