{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T04:29:06Z","timestamp":1776745746826,"version":"3.51.2"},"reference-count":23,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2024,12,2]],"date-time":"2024-12-02T00:00:00Z","timestamp":1733097600000},"content-version":"vor","delay-in-days":1,"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":[[2024,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To determine whether the sonographic appearance of levator ani muscle avulsion after vaginal birth can improve significantly over the first few years postpartum.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a retrospective study of women seen in the context of two prospective perinatal imaging studies. All subjects had undergone an interview, clinical examination and four\u2010dimensional translabial ultrasound on average 4.3\u2009months and 3.1\u2009years postpartum. Volume datasets were analyzed at a later date, with the examiner blinded against all other data. The number of abnormal slices at both timepoints was compared using the Mann\u2013Whitney <jats:italic>U<\/jats:italic>\u2010test. Patients in whom findings had changed over time were reviewed separately, in parallel, in order to reduce the impact of differences in slice location and imaging settings. The symmetry test was used to analyze changes between the two postnatal visits.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 1148 women recruited originally, 315 attended at least two postnatal visits. Forty\u2010two were excluded, leaving 273 women for the final analysis. The mean time of first follow\u2010up was 4.3 (range, 2.6\u20139.8)\u2009months after their first birth and the mean time of last follow\u2010up was 3.1 (range, 1.4\u20138.0)\u2009years postpartum. Cohen's \u03ba for the category of avulsion (normal, partial avulsion and full avulsion) at the two assessments was 0.89, with agreement in 97% (264\/273) of cases. At the first visit, full levator ani muscle avulsion was diagnosed in 20, partial avulsion in 32 and no avulsion in 221 women. While seven partial avulsions appeared sonographically normal at the second visit, there were no statistically significant changes in avulsion category between visits (<jats:italic>P<\/jats:italic>\u2009=\u20090.4).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Tomographic pelvic floor imaging obtained 3\u201310\u2009months after childbirth may be used as a proxy for long\u2010term outcomes. Ultrasound findings at a mean of 3.1\u2009years postpartum showed 97% agreement with findings obtained on imaging at a mean of 4.3\u2009months postpartum. There was a non\u2010significant reduction in abnormal slices at the second follow\u2010up visit, affecting at most 3\/12 slices. This may be explained by compensatory hypertrophy of the remaining intact muscle. Sonographic normalization of full levator ani muscle avulsion was not observed. \u00a9 2024 International Society of Ultrasound in Obstetrics and Gynecology.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.27702","type":"journal-article","created":{"date-parts":[[2024,5,20]],"date-time":"2024-05-20T04:49:10Z","timestamp":1716180550000},"page":"818-823","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Do some levator avulsions improve over time?"],"prefix":"10.1002","volume":"64","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2211-6149","authenticated-orcid":false,"given":"H. P.","family":"Dietz","sequence":"first","affiliation":[{"name":"Sydney Urodynamic Centres  Penrith NSW Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6836-4474","authenticated-orcid":false,"given":"K. L.","family":"Shek","sequence":"additional","affiliation":[{"name":"Western Sydney University  Liverpool NSW Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J.","family":"Descallar","sequence":"additional","affiliation":[{"name":"Ingham Institute for Applied Medical Research  Liverpool NSW Australia"},{"name":"South West Sydney Clinical Campuses School of Clinical Medicine, UNSW Sydney  Sydney NSW Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,12,2]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-020-04669-8"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000250901.57095.ba"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.1072"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-019-03954-5"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.26034"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.16009"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijgo.14208"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.12571"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2015.05.001"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-021-05034-z"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.2731"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.13924"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.3951"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.14719"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.15832"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-010-1329-4"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.11203"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-022-05406-z"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-014-2340-y"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.14840"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.23120"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.13223"},{"issue":"2","key":"e_1_2_7_24_1","first-page":"S274","article-title":"Coronal plane imaging of levator trauma","volume":"33","author":"Dietz H","year":"2022","journal-title":"Int Urogynecol J"}],"container-title":["Ultrasound in Obstetrics &amp; Gynecology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/uog.27702","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,31]],"date-time":"2025-01-31T18:13:46Z","timestamp":1738347226000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1002\/uog.27702"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12]]},"references-count":23,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2024,12]]}},"alternative-id":["10.1002\/uog.27702"],"URL":"https:\/\/doi.org\/10.1002\/uog.27702","archive":["Portico"],"relation":{},"ISSN":["0960-7692","1469-0705"],"issn-type":[{"value":"0960-7692","type":"print"},{"value":"1469-0705","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12]]},"assertion":[{"value":"2024-01-27","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-05-11","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-12-02","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}