{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T12:07:23Z","timestamp":1779451643132,"version":"3.53.1"},"reference-count":46,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T00:00:00Z","timestamp":1765843200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","ejog.org","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["European Journal of Obstetrics &amp; Gynecology and Reproductive Biology"],"published-print":{"date-parts":[[2026,2]]},"DOI":"10.1016\/j.ejogrb.2025.114896","type":"journal-article","created":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T07:12:18Z","timestamp":1765782738000},"page":"114896","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":0,"special_numbering":"C","title":["Association between severity of obstetric perineal tears and risk of levator ani avulsion \u2013 a systematic review"],"prefix":"10.1016","volume":"318","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-4600-2217","authenticated-orcid":false,"given":"Line Norring","family":"Holst","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathrine","family":"Perslev","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niels","family":"Klarskov","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanna","family":"Jang\u00f6","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.ejogrb.2025.114896_b0005","doi-asserted-by":"crossref","DOI":"10.1002\/uog.11080","article-title":"Obstetric levator ani muscle injuries: current status","volume":"39","author":"Schwertner-Tiepelmann","year":"2012","journal-title":"Ultrasound Obstet Gynecol"},{"key":"10.1016\/j.ejogrb.2025.114896_b0010","doi-asserted-by":"crossref","DOI":"10.1007\/s00192-020-04330-4","article-title":"Levator avulsion and vaginal parity: do subsequent vaginal births matter?","volume":"31","author":"Dietz","year":"2020","journal-title":"Int Urogynecol J"},{"key":"10.1016\/j.ejogrb.2025.114896_b0015","doi-asserted-by":"crossref","first-page":"596","DOI":"10.1111\/1471-0528.18036","article-title":"Levator ani deficiency and pelvic floor dysfunction 1\u2009year postpartum: a prospective nested case\u2013control study","volume":"132","author":"Jansson","year":"2025","journal-title":"BJOG"},{"key":"10.1016\/j.ejogrb.2025.114896_b0020","doi-asserted-by":"crossref","DOI":"10.1097\/01.AOG.0000250901.57095.ba","article-title":"Comparison of levator ani muscle defects and function in women with and without pelvic organ prolapse","volume":"109","author":"DeLancey","year":"2007","journal-title":"Obstet Gynecol"},{"key":"10.1016\/j.ejogrb.2025.114896_b0025","doi-asserted-by":"crossref","DOI":"10.1016\/j.ejogrb.2014.08.024","article-title":"Disability-adjusted life years (DALYs) in general population with pelvic organ prolapse: a study based on the prolapse quality-of-life questionnaire (P-QOL)","volume":"182","author":"Svihrova","year":"2014","journal-title":"Eur J Obstetrics Gynecology Reprod Biol"},{"key":"10.1016\/j.ejogrb.2025.114896_b0030","doi-asserted-by":"crossref","DOI":"10.1016\/j.ejogrb.2024.02.044","article-title":"Obstetric risk factors for levator ani muscle avulsion: a systematic review and meta-analysis","volume":"296","author":"Woon Wong","year":"2024","journal-title":"Eur J Obstetrics Gynecol Reprod Biol"},{"key":"10.1016\/j.ejogrb.2025.114896_b0035","doi-asserted-by":"crossref","DOI":"10.1515\/jpm-2013-0269","article-title":"Obstetric anal sphincter injury risk reduction: a retrospective observational analysis","volume":"42","author":"Vathanan","year":"2014","journal-title":"J Perinat Med"},{"key":"10.1016\/j.ejogrb.2025.114896_b0040","doi-asserted-by":"crossref","unstructured":"K L, K F, S R. Obstetric anal sphincter injuries in spontaneous vaginal births in nulliparous pregnant individuals: a 21-year cohort study based on real-world data. Am J Obstet Gynecol 2025. https:\/\/doi.org\/10.1016\/j.ajog.2025.06.014.","DOI":"10.1016\/j.ajog.2025.06.014"},{"key":"10.1016\/j.ejogrb.2025.114896_b0045","unstructured":"RCOG. Care of a third- or fourth-degree tear that occurred during childbirth (also known as obstetric anal sphincter injury OASI) 2019. https:\/\/www.rcog.org.uk\/for-the-public\/browse-our-patient-information\/care-of-a-third-or-fourth-degree-tear-that-occurred-during-childbirth-also-known-as-obstetric-anal-sphincter-injury-oasi\/#:\u223c:text=In%20the%20UK%2C%20a%20third,previously%20had%20a%20vaginal%20birth. (accessed July 2, 2025)."},{"key":"10.1016\/j.ejogrb.2025.114896_b0050","doi-asserted-by":"crossref","DOI":"10.1016\/j.ejogrb.2020.06.048","article-title":"Risk of obstetric anal sphincter injuries (OASIS) and anal incontinence: a meta-analysis","volume":"252","author":"Sideris","year":"2020","journal-title":"Eur J Obstetrics Gynecol Reprod Biol"},{"key":"10.1016\/j.ejogrb.2025.114896_b0055","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-021-91799-8","article-title":"Pelvic floor dysfunction one year after first childbirth in relation to perineal tear severity","volume":"11","author":"Huber","year":"2021","journal-title":"Sci Rep"},{"key":"10.1016\/j.ejogrb.2025.114896_b0060","doi-asserted-by":"crossref","DOI":"10.1111\/ajo.12059","article-title":"Pelvic floor trauma in childbirth","volume":"53","author":"Dietz","year":"2013","journal-title":"Aust N Z J Obstet Gynaecol"},{"key":"10.1016\/j.ejogrb.2025.114896_b0065","doi-asserted-by":"crossref","DOI":"10.1016\/j.ajog.2021.11.570","article-title":"Association of lower degree perineal lacerations at delivery and occult injury of levator ani muscles","volume":"226","author":"Gregory","year":"2022","journal-title":"Am J Obstet Gynecol"},{"key":"10.1016\/j.ejogrb.2025.114896_b0070","doi-asserted-by":"crossref","DOI":"10.1007\/s00192-010-1329-4","article-title":"Minimal criteria for the diagnosis of avulsion of the puborectalis muscle by tomographic ultrasound","volume":"22","author":"Dietz","year":"2011","journal-title":"Int Urogynecol J"},{"key":"10.1016\/j.ejogrb.2025.114896_b0075","article-title":"Interrater reliability of assessing levator ani deficiency with 360\u00b0 3D endovaginal ultrasound","volume":"25","author":"Rostaminia","year":"2014","journal-title":"Int Urogynecol J Pelvic Floor Dysfunct"},{"key":"10.1016\/j.ejogrb.2025.114896_bib212","doi-asserted-by":"crossref","DOI":"10.1097\/AOG.0b013e3181aa2c89","article-title":"Appearance of the levator ani muscle subdivisions in endovaginal three-dimensional ultrasonography","volume":"114","author":"Shobeiri","year":"2009","journal-title":"Obstet Gynecol"},{"key":"10.1016\/j.ejogrb.2025.114896_b0080","doi-asserted-by":"crossref","DOI":"10.1097\/01.AOG.0000194063.63206.1c","article-title":"Obstetric factors associated with levator ani muscle injury after vaginal birth","volume":"107","author":"Kearney","year":"2006","journal-title":"Obstet Gynecol"},{"key":"10.1016\/j.ejogrb.2025.114896_b0085","doi-asserted-by":"crossref","DOI":"10.1053\/beog.2002.0258","article-title":"Lower genital tract and anal sphincter trauma","volume":"16","author":"Sultan","year":"2002","journal-title":"Best Pract Res Clin Obstet Gynaecol"},{"key":"10.1016\/j.ejogrb.2025.114896_b0090","unstructured":"Barjon K, Vadakekut ES, Mahdy H. Episiotomy; 2025."},{"key":"10.1016\/j.ejogrb.2025.114896_b0095","unstructured":"SIGN - methodology checklists n.d. https:\/\/www.sign.ac.uk\/using-our-guidelines\/methodology\/checklists\/ (accessed May 15, 2025)."},{"key":"10.1016\/j.ejogrb.2025.114896_b0100","doi-asserted-by":"crossref","DOI":"10.1007\/s00192-020-04297-2","article-title":"Prediction of levator ani muscle avulsion by genital tears after vaginal birth\u2014a prospective observational cohort study","volume":"31","author":"Kimmich","year":"2020","journal-title":"Int Urogynecol J"},{"key":"10.1016\/j.ejogrb.2025.114896_b0105","doi-asserted-by":"crossref","DOI":"10.1002\/uog.14856","article-title":"Perineal and vaginal tears are clinical markers for occult levator ani trauma: a retrospective observational study","volume":"47","author":"Shek","year":"2016","journal-title":"Ultrasound Obstet Gynecol"},{"key":"10.1016\/j.ejogrb.2025.114896_b0110","doi-asserted-by":"crossref","DOI":"10.1111\/1471-0528.12676","article-title":"Levator ani muscle avulsion during childbirth: a risk prediction model","volume":"121","author":"Van Delft","year":"2014","journal-title":"BJOG"},{"key":"10.1016\/j.ejogrb.2025.114896_b0115","doi-asserted-by":"crossref","DOI":"10.1080\/14767058.2019.1609932","article-title":"Post-partum pelvic floor dysfunction assessed on 3D rotational ultrasound: a prospective study on women with first- and second-degree perineal tears and episiotomy","volume":"34","author":"Leombroni","year":"2021","journal-title":"J Matern Fetal Neonatal Med"},{"key":"10.1016\/j.ejogrb.2025.114896_b0120","doi-asserted-by":"crossref","DOI":"10.3390\/tomography8030105","article-title":"The role of transperineal ultrasound for the assessment of the anorectal angle and its relationship with levator ani muscle avulsion","volume":"8","author":"Garc\u00eda-Mejido","year":"2022","journal-title":"Tomography"},{"key":"10.1016\/j.ejogrb.2025.114896_b0125","doi-asserted-by":"crossref","DOI":"10.1055\/a-1866-7729","article-title":"Association between urinary stress incontinence and levator avulsion detected by 3D transperineal ultrasound","volume":"44","author":"Zhong","year":"2023","journal-title":"Ultraschall Med"},{"key":"10.1016\/j.ejogrb.2025.114896_b0130","doi-asserted-by":"crossref","DOI":"10.1016\/j.ajog.2018.09.025","article-title":"Association of levator injury and urogynecological complaints in women after their first vaginal birth with and without mediolateral episiotomy","volume":"220","author":"Speksnijder","year":"2019","journal-title":"Am J Obstet Gynecol"},{"key":"10.1016\/j.ejogrb.2025.114896_b0135","doi-asserted-by":"crossref","DOI":"10.1007\/s00404-020-05585-4","article-title":"Prevalence of levator ani avulsion in a multicenter study (PAMELA study)","volume":"302","author":"Cassad\u00f3","year":"2020","journal-title":"Arch Gynecol Obstet"},{"key":"10.1016\/j.ejogrb.2025.114896_b0140","doi-asserted-by":"crossref","DOI":"10.1016\/j.ajog.2010.01.002","article-title":"Correlation between levator ani muscle injuries on magnetic resonance imaging and fecal incontinence, pelvic organ prolapse, and urinary incontinence in primiparous women","volume":"202","author":"Heilbrun","year":"2010","journal-title":"Am J Obstet Gynecol"},{"key":"10.1016\/j.ejogrb.2025.114896_b0145","doi-asserted-by":"crossref","DOI":"10.1002\/uog.10062","article-title":"Four-dimensional sonographic evaluation of avulsion of the levator ani according to delivery mode","volume":"38","author":"Cassad\u00f3 Garriga","year":"2011","journal-title":"Ultrasound Obstet Gynecol"},{"key":"10.1016\/j.ejogrb.2025.114896_b0150","doi-asserted-by":"crossref","DOI":"10.7863\/ultra.15.04032","article-title":"Third- or fourth-degree intrapartum anal sphincter tears are associated with levator ani avulsion in primiparas","volume":"35","author":"Valsky","year":"2016","journal-title":"J Ultrasound Med"},{"key":"10.1016\/j.ejogrb.2025.114896_b0155","doi-asserted-by":"crossref","DOI":"10.1002\/uog.15847","article-title":"Is obstetric anal sphincter injury a risk factor for levator ani muscle avulsion in vaginal delivery?","volume":"49","author":"Gonz\u00e1lez","year":"2017","journal-title":"Ultrasound Obstet Gynecol"},{"key":"10.1016\/j.ejogrb.2025.114896_b0160","doi-asserted-by":"crossref","DOI":"10.1007\/s00192-025-06110-4","article-title":"Prevalence and predictors of anal sphincter injuries in primipara with vacuum-assisted deliveries","author":"Gr\u00e4s","year":"2025","journal-title":"Int Urogynecol J"},{"key":"10.1016\/j.ejogrb.2025.114896_b0165","doi-asserted-by":"crossref","DOI":"10.1007\/s00192-024-05756-w","article-title":"Systematic review and meta-analysis of the prevalence of levator ani avulsion with obstetric anal sphincter injury and its effects on pelvic floor dysfunction","volume":"35","author":"Amin","year":"2024","journal-title":"Int Urogynecol J"},{"key":"10.1016\/j.ejogrb.2025.114896_b0170","doi-asserted-by":"crossref","DOI":"10.1111\/aogs.13878","article-title":"Change in prevalence of major levator ani muscle defects from 6 weeks to 1 year postpartum, and maternal and obstetric risk factors: a longitudinal ultrasound study","volume":"99","author":"Halle","year":"2020","journal-title":"Acta Obstet Gynecol Scand"},{"key":"10.1016\/j.ejogrb.2025.114896_b0175","doi-asserted-by":"crossref","DOI":"10.1002\/uog.23120","article-title":"Natural history of levator ani muscle avulsion 4 years following childbirth","volume":"58","author":"van Gruting","year":"2021","journal-title":"Ultrasound Obstet Gynecol"},{"key":"10.1016\/j.ejogrb.2025.114896_bib214","doi-asserted-by":"crossref","first-page":"818","DOI":"10.1002\/uog.27702","article-title":"Do some levator avulsions improve over time?","volume":"64","author":"Dietz","year":"2024","journal-title":"Ultrasound Obstet Gynecol"},{"key":"10.1016\/j.ejogrb.2025.114896_b0180","doi-asserted-by":"crossref","DOI":"10.1002\/uog.24955","article-title":"Diagnostic test accuracy of magnetic resonance imaging and pelvic floor ultrasound for diagnosis of levator ani muscle avulsion","volume":"60","author":"Van Gruting","year":"2022","journal-title":"Ultrasound Obstet Gynecol"},{"key":"10.1016\/j.ejogrb.2025.114896_bib213","first-page":"38","article-title":"Parameter for the Performance of Urogynecological Ultrasound Examinations: Developed in Collaboration with the ACR, the AUGS, the AUA, and the SRU","year":"2019","journal-title":"J Ultrasound in Med"},{"key":"10.1016\/j.ejogrb.2025.114896_b0185","doi-asserted-by":"crossref","DOI":"10.1016\/j.midw.2022.103494","article-title":"A review of levator ani avulsion after childbirth: Incidence, imaging and management","volume":"115","author":"Doxford-Hook","year":"2022","journal-title":"Midwifery"},{"key":"10.1016\/j.ejogrb.2025.114896_bib211","doi-asserted-by":"crossref","unstructured":"O\u2019Brien CP. Pelvic Floor and Sphincter Neuropathy After Childbirth. Pelvic Floor, Perineal, and Anal Sphincter Trauma During Childbirth, Cham: Springer International Publishing; 2024, p. 293\u2013316. https:\/\/doi.org\/10.1007\/978-3-031-43095-4_17.","DOI":"10.1007\/978-3-031-43095-4_17"},{"key":"10.1016\/j.ejogrb.2025.114896_b0190","doi-asserted-by":"crossref","unstructured":"L\u00f8wenstein E, Ottesen B, Gimbel H. Incidence and lifetime risk of pelvic organ prolapse surgery in Denmark from 1977 to 2009. Int Urogynecol J 2015;26. https:\/\/doi.org\/10.1007\/s00192-014-2413-y.","DOI":"10.1007\/s00192-014-2413-y"},{"key":"10.1016\/j.ejogrb.2025.114896_b0195","doi-asserted-by":"crossref","DOI":"10.1016\/j.ejogrb.2011.04.029","article-title":"The prevalence and factors associated with previous surgery for pelvic organ prolapse and\/or urinary incontinence in a cross-sectional study in the Netherlands","volume":"158","author":"De Boer","year":"2011","journal-title":"Eur J Obstetrics Gynecol Reprod Biol"},{"key":"10.1016\/j.ejogrb.2025.114896_b0200","doi-asserted-by":"crossref","DOI":"10.1002\/uog.7678","article-title":"Levator avulsion is a risk factor for cystocele recurrence","volume":"36","author":"Dietz","year":"2010","journal-title":"Ultrasound Obstet Gynecol"},{"key":"10.1016\/j.ejogrb.2025.114896_b0205","doi-asserted-by":"crossref","DOI":"10.1111\/j.1600-0412.2010.01037.x","article-title":"Complete rupture of anal sphincter in primiparas: long-term effects and subsequent delivery","volume":"90","author":"Wegnelius","year":"2011","journal-title":"Acta Obstet Gynecol Scand"},{"key":"10.1016\/j.ejogrb.2025.114896_b0210","doi-asserted-by":"crossref","DOI":"10.1097\/SPV.0000000000000954","article-title":"Adding Insult to Injury: Levator Ani Avulsion in Women with Obstetric Anal Sphincter Injuries","volume":"27","author":"Heliker","year":"2021","journal-title":"Female Pelvic Med Reconstr Surg"}],"container-title":["European Journal of Obstetrics &amp; Gynecology and Reproductive Biology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0301211525011728?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0301211525011728?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T11:24:41Z","timestamp":1779449081000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0301211525011728"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2]]},"references-count":46,"alternative-id":["S0301211525011728"],"URL":"https:\/\/doi.org\/10.1016\/j.ejogrb.2025.114896","relation":{},"ISSN":["0301-2115"],"issn-type":[{"value":"0301-2115","type":"print"}],"subject":[],"published":{"date-parts":[[2026,2]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Association between severity of obstetric perineal tears and risk of levator ani avulsion \u2013 a systematic review","name":"articletitle","label":"Article Title"},{"value":"European Journal of Obstetrics & Gynecology and Reproductive Biology","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.ejogrb.2025.114896","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2025 The Authors. Published by Elsevier B.V.","name":"copyright","label":"Copyright"}],"article-number":"114896"}}