{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T01:44:46Z","timestamp":1788399886672,"version":"build-2803163510"},"reference-count":29,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2021,8,3]],"date-time":"2021-08-03T00:00:00Z","timestamp":1627948800000},"content-version":"vor","delay-in-days":2,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp; Gyne"],"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>The primary aim was to evaluate prospectively the natural history of levator ani muscle (LAM) avulsion 4\u2009years following first delivery and its correlation with signs and symptoms of pelvic floor dysfunction (PFD). The secondary aim was to investigate the effect of a second vaginal delivery on the incidence of LAM avulsion and PFD.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a prospective longitudinal study of nulliparous women recruited antenatally, who were assessed at 36\u2009weeks' gestation and 3\u2009months, 1\u2009year and 4\u2009years postpartum for signs and symptoms of PFD and presence of LAM avulsion. Pelvic floor muscle strength was assessed by digital palpation, and pelvic organ prolapse (POP) was assessed using the POP quantification (POP\u2010Q) system. Validated questionnaires were used to evaluate urinary, bowel and sexual function and symptoms of POP. Transperineal ultrasound was performed to assess LAM integrity and hiatal biometry. Differences in signs and symptoms of PFD over time were evaluated using a linear mixed model, separately in women who had had one delivery and in those who had two or more deliveries during the study period.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 269 women recruited, 147 (55%) attended the 4\u2010year follow\u2010up and were examined at a mean interval of 3.8\u2009\u00b1\u20090.4\u2009years after their first delivery. Of these, 74 (50%) had a subsequent delivery. The prevalence of LAM avulsion 4\u2009years after a first vaginal delivery was 13%, with no difference between women who had one and those who had two or more vaginal deliveries. Women with an intact LAM and one or more deliveries showed no change in signs and symptoms of PFD at 4\u2009years compared with the previous assessments. Of women with one vaginal delivery who were diagnosed with LAM avulsion 3\u2009months or 1\u2009year postpartum, those in whom the LAM avulsion was no longer evident at 4\u2009years (42%) showed  worsening of POP\u2010Q measurements, whereas those with persistent LAM avulsion (58%) showed significant worsening in pelvic floor muscle strength and hiatal area on ultrasound. After a second vaginal delivery, no new avulsions were diagnosed, however, previous LAM avulsion became more extensive in 44% of women and hiatal area increased in women with persistent LAM avulsion.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The first vaginal delivery carries the greatest risk for LAM avulsion, with impact on signs of PFD 4\u2009years later. A second vaginal delivery could result in deterioration of LAM avulsion, but no new avulsions were found. \u00a9 2020 International Society of Ultrasound in Obstetrics and Gynecology<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.23120","type":"journal-article","created":{"date-parts":[[2020,9,16]],"date-time":"2020-09-16T22:33:56Z","timestamp":1600295636000},"page":"309-317","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Natural history of levator ani muscle avulsion 4\u2009years following childbirth"],"prefix":"10.1002","volume":"58","author":[{"given":"I. M. A.","family":"van Gruting","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynaecology Croydon University Hospital  Croydon UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K. W. M.","family":"van Delft","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Radboud University Medical Centre  Nijmegen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. H.","family":"Sultan","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Croydon University Hospital  Croydon UK"},{"name":"Department of Obstetrics and Gynaecology St George's University of London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Thakar","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Croydon University Hospital  Croydon UK"},{"name":"Department of Obstetrics and Gynaecology St George's University of London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,8,3]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000250901.57095.ba"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2008.01751.x"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.5355"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-017-3390-8"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-017-3475-4"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000001272"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.12676"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.13332"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.12666"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.13223"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.13878"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.12075"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.16009"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.17446"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.12920"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-018-3616-4"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-020-04330-4"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.13252"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/nau.20041"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1136\/gut.44.1.77"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2006.00938.x"},{"key":"e_1_2_8_23_1","first-page":"42","volume-title":"Pelvic floor re\u2010education, Principles and practice","author":"Laycock J.","year":"1994"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9378(96)70091-1"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.3951"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-010-1329-4"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.11203"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.1097\/SPV.0000000000000644"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2019.03.004"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.12592"}],"container-title":["Ultrasound in Obstetrics &amp; Gynecology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/uog.23120","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/uog.23120","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/uog.23120","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,28]],"date-time":"2023-08-28T03:58:53Z","timestamp":1693195133000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1002\/uog.23120"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8]]},"references-count":29,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2021,8]]}},"alternative-id":["10.1002\/uog.23120"],"URL":"https:\/\/doi.org\/10.1002\/uog.23120","archive":["Portico"],"relation":{},"ISSN":["0960-7692","1469-0705"],"issn-type":[{"value":"0960-7692","type":"print"},{"value":"1469-0705","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8]]},"assertion":[{"value":"2020-06-22","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-09-03","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-08-03","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}