{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T08:10:12Z","timestamp":1769760612710,"version":"3.49.0"},"reference-count":30,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2017,6,5]],"date-time":"2017-06-05T00:00:00Z","timestamp":1496620800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Health Medical Research Fund"},{"name":"Food and Health Bureau of Hong Kong, SAR"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet & Gyne"],"published-print":{"date-parts":[[2017,7]]},"abstract":"ABSTRACT<\/jats:title>Objectives<\/jats:title>To evaluate the morphological outcome of levator ani muscle (LAM<\/jats:styled-content>) avulsion 3\u20135 years after a first delivery and to assess the effect of a second delivery on this condition. The impact of LAM<\/jats:styled-content> avulsion on pelvic floor disorders was also studied.<\/jats:p><\/jats:sec>Methods<\/jats:title>Six hundred and sixty\u2010six women who had been assessed for LAM<\/jats:styled-content> avulsion 8 weeks after their first delivery were invited for a follow\u2010up examination 3\u20135 years later. Women completed the Pelvic Floor Distress Inventory including the Urinary Distress Inventory (UDI<\/jats:styled-content>) and Pelvic Organ Prolapse Distress Inventory (POPDI<\/jats:styled-content>) questionnaires to explore symptoms of pelvic floor disorders, and the pelvic floor was examined using three\u2010dimensional translabial ultrasound and assessed using the pelvic organ prolapse quantification system.<\/jats:p><\/jats:sec>Results<\/jats:title>Three hundred and ninety\u2010nine women completed the study, of whom 151 were multiparous. Mean interval between first delivery and follow\u2010up was 42.3\u2009\u00b1\u20097.6\u2009months. Among 69 women who had LAM<\/jats:styled-content> avulsion 8 weeks after their first delivery, nine (13.0%) had no LAM<\/jats:styled-content> avulsion at follow\u2010up. One (0.9%) woman had a new LAM<\/jats:styled-content> avulsion after her second vaginal delivery. A greater proportion of women with LAM<\/jats:styled-content> avulsion reported symptoms of stress urinary incontinence (SUI<\/jats:styled-content>) (adjusted odds ratio, 2.09 (95% CI<\/jats:styled-content>, 1.18\u20133.70); P<\/jats:italic>\u2009=\u20090.01) and symptoms of prolapse than did women without avulsion; however, this difference did not reach statistical significance (P<\/jats:italic>\u2009=\u20090.61). Women with LAM<\/jats:styled-content> avulsion had higher UDI<\/jats:styled-content> and POPDI<\/jats:styled-content> scores than did women without avulsion (median UDI<\/jats:styled-content> score, 17.7 (interquartile range (IQR<\/jats:styled-content>), 5.0\u201332.4) vs<\/jats:italic> 9.2 (IQR<\/jats:styled-content>, 0.0\u201322.1); P<\/jats:italic>\u2009=\u20090.045 and median POPDI<\/jats:styled-content> score, 20.8 (IQR<\/jats:styled-content>, 8.8\u201340.5) vs<\/jats:italic> 10.7 (IQR<\/jats:styled-content>, 0.0\u201332.8); P<\/jats:italic>\u2009=\u20090.021).<\/jats:p><\/jats:sec>Conclusions<\/jats:title>The risk of developing new LAM<\/jats:styled-content> avulsion after a second vaginal delivery is low (0.9%). Healing of LAM<\/jats:styled-content> avulsion was observed in 13% of women who had at least one vaginal delivery. At 3\u20135 years after delivery, women with LAM<\/jats:styled-content> avulsion reported symptoms of SUI<\/jats:styled-content> more often than did those without, and had higher UDI<\/jats:styled-content> and POPDI<\/jats:styled-content> scores, implying more bothersome symptoms. Copyright \u00a9 2016 ISUOG. Published by John Wiley & Sons Ltd.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.16009","type":"journal-article","created":{"date-parts":[[2016,7,1]],"date-time":"2016-07-01T12:17:03Z","timestamp":1467375423000},"page":"110-115","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":28,"title":["Longitudinal follow\u2010up of levator ani muscle avulsion: does a second delivery affect it?"],"prefix":"10.1002","volume":"50","author":[{"given":"S. S. C.","family":"Chan","sequence":"first","affiliation":[{"name":"Department of Obstetrics & Gynaecology, Faculty of Medicine Chinese University of Hong Kong Hong Kong SAR"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R. Y. K.","family":"Cheung","sequence":"additional","affiliation":[{"name":"Department of Obstetrics & Gynaecology, Faculty of Medicine Chinese University of Hong Kong Hong Kong SAR"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L. L.","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Obstetrics & Gynaecology, Faculty of Medicine Chinese University of Hong Kong Hong Kong SAR"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R. K. W.","family":"Choy","sequence":"additional","affiliation":[{"name":"Department of Obstetrics & Gynaecology, Faculty of Medicine Chinese University of Hong Kong Hong Kong SAR"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"T. K. H.","family":"Chung","sequence":"additional","affiliation":[{"name":"Department of Obstetrics & Gynaecology, Faculty of Medicine Chinese University of Hong Kong Hong Kong SAR"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2017,6,5]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000178779.62181.01"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2010.02704.x"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.10132"},{"key":"e_1_2_6_5_1","first-page":"616","article-title":"Prevalence and trends of symptomatic pelvic floor disorders before and six weeks after the first delivery\u00a0\u2013\u00a0longitudinal study","volume":"32","author":"Dlouha K","year":"2013","journal-title":"Neurourol 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