{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T17:03:51Z","timestamp":1780506231607,"version":"3.54.1"},"reference-count":30,"publisher":"Springer Science and Business Media LLC","issue":"3","license":[{"start":{"date-parts":[[2019,12,4]],"date-time":"2019-12-04T00:00:00Z","timestamp":1575417600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2019,12,4]],"date-time":"2019-12-04T00:00:00Z","timestamp":1575417600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100004876","name":"Sheffield Hospitals Charity","doi-asserted-by":"publisher","award":["121341"],"award-info":[{"award-number":["121341"]}],"id":[{"id":"10.13039\/501100004876","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Int Urogynecol J"],"published-print":{"date-parts":[[2020,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n<jats:title>Introduction and hypothesis<\/jats:title>\n<jats:p>Vaginal childbirth is associated with pelvic floor muscle (PFM) damage in a third of women. The biomechanics prediction, detection and management of PFM damage remain poorly understood. We sought in this pilot study to determine whether quantifying PFM stiffness postnatally by vaginal elastometry, in women attending a perineal trauma clinic (PTC) within 6\u00a0months of obstetric anal sphincter injury, correlates with their antecedent labour characteristics, pelvic floor muscle damage, or urinary\/bowel\/sexual symptoms, to inform future definitive prospective studies.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>In this pilot study, we measured postnatal PFM stiffness by vaginal elastometry in 54 women. A subset of participants (<jats:italic>n<\/jats:italic>\u2009=\u200914) underwent magnetic resonance imaging (MRI) to define any levator ani (LA) muscle defects from vaginal childbirth. We investigated the association of PFM stiffness with demographics, labour and delivery characteristics, clinical features and MRI evidence of LA damage.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Raised maternal BMI was associated with reduced pelvic floor stiffness (r\u2009=\u2009\u22120.4; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01). Higher stiffness values were associated with forceps delivery for delayed second stage of labour (<jats:italic>n<\/jats:italic>\u2009=\u200914) vs non-forceps vaginal delivery (<jats:italic>n<\/jats:italic>\u2009=\u200940; 630\u2009\u00b1\u200940 N\/m vs 500\u2009\u00b1\u200930 N\/m; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05), and a non-significant trend towards longer duration of the second stage of labour. Women with urinary, bowel or sexual symptoms (<jats:italic>n<\/jats:italic>\u2009=\u200937) demonstrated higher pelvic floor stiffness values than those without (570\u2009\u00b1\u200930 N\/m vs 450\u2009\u00b1\u200940 N\/m; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05).<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>A history of delayed second stage of labour and forceps delivery was associated with higher PFM stiffness values in the postnatal period. Whether high pelvic muscle stiffness antenatally is a risk factor for instrumental vaginal delivery and LA avulsion is unknown.<\/jats:p>\n<\/jats:sec>","DOI":"10.1007\/s00192-019-04136-z","type":"journal-article","created":{"date-parts":[[2019,12,4]],"date-time":"2019-12-04T09:07:50Z","timestamp":1575450470000},"page":"567-575","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Postnatal pelvic floor muscle stiffness measured by vaginal elastometry in women with obstetric anal sphincter injury: a pilot study"],"prefix":"10.1007","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2502-3033","authenticated-orcid":false,"given":"Dilly O. C.","family":"Anumba","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siobh\u00e1n","family":"Gillespie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Swati","family":"Jha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shahram","family":"Abdi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenny","family":"Kruger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Taberner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Poul M. F.","family":"Nielsen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinshan","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2019,12,4]]},"reference":[{"issue":"6445","key":"4136_CR1","doi-asserted-by":"publisher","first-page":"587","DOI":"10.1136\/bmj.289.6445.587","volume":"289","author":"J Sleep","year":"1984","unstructured":"Sleep J, Grant A, Garcia J, Elbourne D, Spencer J, Chalmers I. West Berkshire perineal management trial. Br Med J (Clin Res Ed). 1984;289(6445):587\u201390.","journal-title":"Br Med J (Clin Res Ed)"},{"issue":"4","key":"4136_CR2","doi-asserted-by":"publisher","first-page":"707","DOI":"10.1097\/01.AOG.0000178779.62181.01","volume":"106","author":"HP Dietz","year":"2005","unstructured":"Dietz HP, Lanzarone V. Levator trauma after vaginal delivery. Obstet Gynecol. 2005;106(4):707\u201312.","journal-title":"Obstet Gynecol"},{"issue":"26","key":"4136_CR3","doi-asserted-by":"publisher","first-page":"1905","DOI":"10.1056\/NEJM199312233292601","volume":"329","author":"AH Sultan","year":"1993","unstructured":"Sultan AH, Kamm MA, Hudson CN, Thomas JM, Bartram CI. Anal-sphincter disruption during vaginal delivery. N Engl J Med. 1993;329(26):1905\u201311.","journal-title":"N Engl J Med"},{"issue":"1","key":"4136_CR4","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1016\/S0301-2115(98)00175-4","volume":"82","author":"F Chiaffarino","year":"1999","unstructured":"Chiaffarino F, Chatenoud L, Dindelli M, Meschia M, Buonaguidi A, Amicarelli F, et al. Reproductive factors, family history, occupation and risk of urogenital prolapse. Eur J Obstet Gynecol Reprod Biol. 1999;82(1):63\u20137.","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"4136_CR5","first-page":"21","volume-title":"Textbook of female urology and urogynaecology","author":"CW McGrother","year":"2001","unstructured":"McGrother CW, Shaw C, Perry SI, Dallosso HM, Mensah FK. Epidemiology (Europe). In: Cardozo L, Staskin D, editors. Textbook of female urology and urogynaecology. Oxford: Oxford Isis Medical Media; 2001. p. 21\u201335."},{"issue":"6","key":"4136_CR6","doi-asserted-by":"publisher","first-page":"927","DOI":"10.1007\/s00192-012-1932-7","volume":"24","author":"K Elenskaia","year":"2013","unstructured":"Elenskaia K, Thakar R, Sultan AH, Scheer I, Onwude J. Effect of childbirth on pelvic organ support and quality of life: a longitudinal cohort study. Int Urogynecol J. 2013;24(6):927\u201337.","journal-title":"Int Urogynecol J"},{"issue":"1","key":"4136_CR7","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1097\/01.AOG.0000194063.63206.1c","volume":"107","author":"R Kearney","year":"2006","unstructured":"Kearney R, Miller JM, Ashton-Miller JA, DeLancey JO. Obstetric factors associated with levator ani muscle injury after vaginal birth. Obstet Gynecol. 2006;107(1):144\u20139.","journal-title":"Obstet Gynecol"},{"issue":"2","key":"4136_CR8","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2011-000206","volume":"1","author":"M Abdel-Fattah","year":"2011","unstructured":"Abdel-Fattah M, Familusi A, Fielding S, Ford J, Bhattacharya S. Primary and repeat surgical treatment for female pelvic organ prolapse and incontinence in parous women in the UK: a register linkage study. BMJ Open. 2011;1(2):e000206.","journal-title":"BMJ Open"},{"issue":"4","key":"4136_CR9","doi-asserted-by":"publisher","first-page":"485","DOI":"10.1007\/s10237-010-0249-z","volume":"10","author":"X Li","year":"2011","unstructured":"Li X, Kruger JA, Nash MP, Nielsen PM. Anisotropic effects of the levator ani muscle during childbirth. Biomech Model Mechanobiol. 2011;10(4):485\u201394.","journal-title":"Biomech Model Mechanobiol"},{"issue":"3","key":"4136_CR10","doi-asserted-by":"publisher","first-page":"455","DOI":"10.1016\/j.jbiomech.2011.12.002","volume":"45","author":"D Jing","year":"2012","unstructured":"Jing D, Ashton-Miller JA, DeLancey JO. A subject-specific anisotropic visco-hyperelastic finite element model of female pelvic floor stress and strain during the second stage of labor. J Biomech. 2012;45(3):455\u201360.","journal-title":"J Biomech"},{"issue":"7","key":"4136_CR11","doi-asserted-by":"publisher","first-page":"648","DOI":"10.1002\/nau.10156","volume":"22","author":"C Dumoulin","year":"2003","unstructured":"Dumoulin C, Bourbonnais D, Lemieux MC. Development of a dynamometer for measuring the isometric force of the pelvic floor musculature. Neurourol Urodyn. 2003;22(7):648\u201353.","journal-title":"Neurourol Urodyn"},{"issue":"8","key":"4136_CR12","doi-asserted-by":"publisher","first-page":"819","DOI":"10.1002\/nau.20603","volume":"27","author":"M Morin","year":"2008","unstructured":"Morin M, Gravel D, Bourbonnais D, Dumoulin C, Ouellet S. Reliability of dynamometric passive properties of the pelvic floor muscles in postmenopausal women with stress urinary incontinence. Neurourol Urodyn. 2008;27(8):819\u201325.","journal-title":"Neurourol Urodyn"},{"key":"4136_CR13","volume-title":"The management of third- and fourth-degree perineal tears, green-top guidelines no. 29","author":"RCOG","year":"2007","unstructured":"RCOG. The management of third- and fourth-degree perineal tears, green-top guidelines no. 29. London: RCOG; 2007."},{"issue":"5","key":"4136_CR14","doi-asserted-by":"publisher","first-page":"633","DOI":"10.1007\/s00192-011-1583-0","volume":"23","author":"S Jha","year":"2012","unstructured":"Jha S, Strelley K, Radley S. Incontinence during intercourse: myths unravelled. Int Urogynecol J. 2012;23(5):633\u20137.","journal-title":"Int Urogynecol J"},{"issue":"8","key":"4136_CR15","doi-asserted-by":"publisher","first-page":"1007","DOI":"10.1111\/j.1471-0528.2000.tb10404.x","volume":"107","author":"PJ Isherwood","year":"2000","unstructured":"Isherwood PJ, Rane A. Comparative assessment of pelvic floor strength using a perineometer and digital examination. BJOG. 2000;107(8):1007\u201311.","journal-title":"BJOG"},{"issue":"2","key":"4136_CR16","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1002\/nau.22537","volume":"34","author":"JA Kruger","year":"2015","unstructured":"Kruger JA, Nielsen PM, Budgett SC, Taberner AJ. An automated hand-held elastometer for quantifying the passive stiffness of the levator ani muscle in women. Neurourol Urodyn. 2015;34(2):133\u20138.","journal-title":"Neurourol Urodyn"},{"issue":"10","key":"4136_CR17","doi-asserted-by":"publisher","first-page":"1234","DOI":"10.1111\/aogs.13186","volume":"96","author":"JA Kruger","year":"2017","unstructured":"Kruger JA, Budgett SC, Wong V, Nielsen PMF, Nash MP, Smalldridge J, et al. Characterising levator-ani muscle stiffness pre- and post-childbirth in European and Polynesian women in New Zealand: a pilot study. Acta Obstet Gynecol Scand. 2017;96(10):1234\u201342.","journal-title":"Acta Obstet Gynecol Scand"},{"issue":"10","key":"4136_CR18","first-page":"CD011900","volume":"2105","author":"IMA Van Gruting","year":"2015","unstructured":"Van Gruting IMA, Van Delft KWM, Thakar R, IntHout J, Sultan AH. Accuracy of MRI, ultrasound and vaginal assessment for the diagnosis of levator ani muscle avulsion in women. Cochrane Database Syst Rev. 2015;2105(10):CD011900.","journal-title":"Cochrane Database Syst Rev"},{"issue":"1","key":"4136_CR19","first-page":"46","volume":"101","author":"JO DeLancey","year":"2003","unstructured":"DeLancey JO, Kearney R, Chou Q, Speights S, Binno S. The appearance of levator ani muscle abnormalities in magnetic resonance images after vaginal delivery. Obstet Gynecol. 2003;101(1):46\u201353.","journal-title":"Obstet Gynecol"},{"issue":"10","key":"4136_CR20","doi-asserted-by":"publisher","first-page":"1337","DOI":"10.1007\/s00192-008-0655-2","volume":"19","author":"GL Jones","year":"2008","unstructured":"Jones GL, Radley SC, Lumb J, Jha S. Electronic pelvic floor symptoms assessment: tests of data quality of ePAQ-PF. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(10):1337\u201347.","journal-title":"Int Urogynecol J Pelvic Floor Dysfunct"},{"issue":"12","key":"4136_CR21","doi-asserted-by":"publisher","first-page":"1485","DOI":"10.1111\/j.1471-0528.2010.02704.x","volume":"117","author":"KL Shek","year":"2010","unstructured":"Shek KL, Dietz HP. Intrapartum risk factors for levator trauma. BJOG. 2010;117(12):1485\u201392.","journal-title":"BJOG"},{"issue":"4","key":"4136_CR22","doi-asserted-by":"publisher","first-page":"372","DOI":"10.1002\/uog.11080","volume":"39","author":"N Schwertner-Tiepelmann","year":"2012","unstructured":"Schwertner-Tiepelmann N, Thakar R, Sultan AH, Tunn R. Obstetric levator ani muscle injuries: current status. Ultrasound Obstet Gynecol. 2012;39(4):372\u201383.","journal-title":"Ultrasound Obstet Gynecol"},{"issue":"2","key":"4136_CR23","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1007\/s00192-011-1530-0","volume":"23","author":"Y Lavy","year":"2012","unstructured":"Lavy Y, Sand PK, Kaniel CI, Hochner-Celnikier D. Can pelvic floor injury secondary to delivery be prevented? Int Urogynecol J. 2012;23(2):165\u201373.","journal-title":"Int Urogynecol J"},{"issue":"6","key":"4136_CR24","doi-asserted-by":"publisher","first-page":"586.e1","DOI":"10.1016\/j.ajog.2009.11.038","volume":"202","author":"KL Shek","year":"2010","unstructured":"Shek KL, Dietz HP. Can levator avulsion be predicted antenatally? Am J Obstet Gynecol. 2010;202(6):586.e1\u20136.","journal-title":"Am J Obstet Gynecol"},{"issue":"2","key":"4136_CR25","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1007\/s00192-015-2822-6","volume":"27","author":"LH Gagnon","year":"2016","unstructured":"Gagnon LH, Boucher J, Robert M. Impact of pelvic floor muscle training in the postpartum period. Int Urogynecol J. 2016;27(2):255\u201360.","journal-title":"Int Urogynecol J"},{"issue":"4","key":"4136_CR26","doi-asserted-by":"publisher","first-page":"1001","DOI":"10.1007\/s00404-019-05070-7","volume":"299","author":"E Martinez Franco","year":"2019","unstructured":"Martinez Franco E, Lopez Negre JL, Pares D, Ros Cerro C, Amat Tardiu L, Cuadras D, et al. Anatomic and functional evaluation of the levator ani muscle after an obstetric anal sphincter injury. Arch Gynecol Obstet. 2019;299(4):1001\u20136.","journal-title":"Arch Gynecol Obstet"},{"issue":"2","key":"4136_CR27","doi-asserted-by":"publisher","first-page":"262","DOI":"10.1002\/uog.19195","volume":"53","author":"MO Nyhus","year":"2019","unstructured":"Nyhus MO, Salvesen KA, Volloyhaug I. Association between pelvic floor muscle trauma and contraction in parous women from a general population. Ultrasound Obstet Gynecol. 2019;53(2):262\u20138.","journal-title":"Ultrasound Obstet Gynecol"},{"issue":"3","key":"4136_CR28","doi-asserted-by":"publisher","first-page":"410","DOI":"10.1002\/uog.20115","volume":"53","author":"I Volloyhaug","year":"2019","unstructured":"Volloyhaug I, Taithongchai A, Van Gruting I, Sultan A, Thakar R. Levator ani muscle morphology and function in women with obstetric anal sphincter injury. Ultrasound Obstet Gynecol. 2019;53(3):410\u20136.","journal-title":"Ultrasound Obstet Gynecol"},{"issue":"1","key":"4136_CR29","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1111\/j.1471-0528.1994.tb13005.x","volume":"101","author":"AH Sultan","year":"1994","unstructured":"Sultan AH, Kamm MA, Hudson CN. Pudendal nerve damage during labour: prospective study before and after childbirth. Br J Obstet Gynaecol. 1994;101(1):22\u20138.","journal-title":"Br J Obstet Gynaecol"},{"issue":"8402","key":"4136_CR30","doi-asserted-by":"publisher","first-page":"546","DOI":"10.1016\/S0140-6736(84)90766-9","volume":"2","author":"SJ Snooks","year":"1984","unstructured":"Snooks SJ, Setchell M, Swash M, Henry MM. Injury to innervation of pelvic floor sphincter musculature in childbirth. Lancet. 1984;2(8402):546\u201350.","journal-title":"Lancet"}],"container-title":["International Urogynecology Journal"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1007\/s00192-019-04136-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1007\/s00192-019-04136-z\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1007\/s00192-019-04136-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,12,3]],"date-time":"2020-12-03T01:45:35Z","timestamp":1606959935000},"score":1,"resource":{"primary":{"URL":"http:\/\/link.springer.com\/10.1007\/s00192-019-04136-z"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,12,4]]},"references-count":30,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2020,3]]}},"alternative-id":["4136"],"URL":"https:\/\/doi.org\/10.1007\/s00192-019-04136-z","relation":{},"ISSN":["0937-3462","1433-3023"],"issn-type":[{"value":"0937-3462","type":"print"},{"value":"1433-3023","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,12,4]]},"assertion":[{"value":"17 April 2019","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 September 2019","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 December 2019","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"The study was approved by the North Sheffield Research Ethics committee (NRES REC Number 14\/NE\/1014).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"None.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflicts of interest"}}]}}