{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,4,5]],"date-time":"2025-04-05T10:45:13Z","timestamp":1743849913926,"version":"3.37.3"},"reference-count":29,"publisher":"Georg Thieme Verlag KG","issue":"02","funder":[{"name":"Vaduz, Liechtenstein"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Z Geburtshilfe Neonatol"],"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\nIntroduction Trauma of the levator ani muscle (LAM) is common after\nvaginal birth and can most reliably be diagnosed by 3-dimensional (3D)\ntranslabial ultrasound (TLUS). Multiple risk factors are known in general, but\nnot in association to a specific side of the body. Therefore, our aim was to\nevaluate different impact factors which cause LAM trauma on either side of the\nbody or bilateral by focusing on the fetal position at birth.<\/jats:p><jats:p>\nMaterial and Methods As part of a prospective cohort study between\n3\/2017 and 4\/2019, we analyzed vaginal births of nulliparous\nwomen with singletons in vertex presentation\u226536+0 gestational\nweeks. We evaluated their pelvic floor for hematomas, partial and complete LAM\navulsions by 3D TLUS 2\u20134 days postpartum and searched for an association\nbetween the affected body side and different fetal, maternal and obstetrical\nfactors.<\/jats:p><jats:p>\nResults 71 out of 213 women (33.3%) suffered from LAM trauma\n\u2013 17 (23.9%) on the right side, 20 (28.2%) on the left\nside and 34 (47.9%) bilateral. No association between the different\nevaluated factors and the affected body side could be identified, except for the\nquality of fetal heart rate tracing.<\/jats:p><jats:p>\nConclusions No significant impact factors of LAM trauma could be\nassociated with a specific side of the body. Other possible mechanisms need\ninvestigation in the future, such as the time of the birth canal and the fetus\nto adapt to each other, including adequate time for the tissue to stretch and\nthe fetus to rotate into the ideal position within the LAM hiatus.<\/jats:p>","DOI":"10.1055\/a-1153-9387","type":"journal-article","created":{"date-parts":[[2020,5,7]],"date-time":"2020-05-07T22:39:26Z","timestamp":1588891166000},"page":"134-139","source":"Crossref","is-referenced-by-count":2,"title":["Association between the side of levator Ani muscle trauma and fetal\nposition at birth \u2013 a prospective observational study"],"prefix":"10.1055","volume":"225","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0789-425X","authenticated-orcid":false,"given":"Nina","family":"Kimmich","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, University Hospital Zurich, Zurich,\nSwitzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jana","family":"Birri","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, University Hospital Zurich, Zurich,\nSwitzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roland","family":"Zimmermann","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, University Hospital Zurich, Zurich,\nSwitzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martina","family":"Kreft","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, University Hospital Zurich, Zurich,\nSwitzerland"},{"name":"Sydney Ultrasound for Women, Sydney, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2020,5,7]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"1155","DOI":"10.1111\/1471-0528.12676","article-title":"Levator ani muscle avulsion during childbirth: a risk prediction model","volume":"121","author":"K van Delft","year":"2014","journal-title":"BJOG"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"1266","DOI":"10.1111\/1471-0528.13223","article-title":"The natural history of levator avulsion one year following childbirth: a\nprospective study","volume":"122","author":"K W van Delft","year":"2015","journal-title":"BJOG"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1111\/ajo.12059","article-title":"Pelvic floor trauma in childbirth","volume":"53","author":"H P Dietz","year":"2013","journal-title":"Aust N Z J Obstet Gynaecol"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"1485","DOI":"10.1111\/j.1471-0528.2010.02704.x","article-title":"Intrapartum risk factors for levator trauma","volume":"117","author":"K L Shek","year":"2010","journal-title":"BJOG"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/j.ijgo.2010.05.019","article-title":"Levator ani injury in primiparous women with forceps delivery for fetal\ndistress, forceps for second stage arrest, and spontaneous delivery","volume":"111","author":"R Kearney","year":"2010","journal-title":"Int J Gynaecol Obstet"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1002\/nau.24167","article-title":"Are there differences in the damage to the pelvic floor between\nMalmstrom\u2019s and Kiwi omnicup vacuums? A multicenter study","volume":"39","author":"E Gonzalez-Diaz","year":"2019","journal-title":"Neurourol Urodyn"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1080\/14767058.2017.1293022","article-title":"Influence of difficulty of instrumentation with vacuum on the rate of levator\nani muscle avulsion identified by 3-4 D transperineal ultrasound","volume":"31","author":"J A Garcia Mejido","year":"2018","journal-title":"J Matern Fetal Neonatal Med"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"867","DOI":"10.1111\/1471-0528.12920","article-title":"The association between vaginal parity and hiatal dimensions: a retrospective\nobservational study in a tertiary urogynaecological centre","volume":"122","author":"I Kamisan Atan","year":"2015","journal-title":"BJOG"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1002\/uog.13252","article-title":"Pelvic floor trauma: does the second baby matter?","volume":"44","author":"T A Horak","year":"2014","journal-title":"Ultrasound Obstet Gynecol"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1002\/uog.1072","article-title":"Ultrasound imaging of the pelvic floor. Part II: three-dimensional or volume\nimaging","volume":"23","author":"H P Dietz","year":"2004","journal-title":"Ultrasound Obstet Gynecol"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1002\/uog.6268","article-title":"The levator-urethra gap measurement: a more objective means of determining\nlevator avulsion?","volume":"32","author":"H P Dietz","year":"2008","journal-title":"Ultrasound Obstet Gynecol"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1007\/s00192-010-1329-4","article-title":"Minimal criteria for the diagnosis of avulsion of the puborectalis muscle by\ntomographic ultrasound","volume":"22","author":"H P Dietz","year":"2011","journal-title":"Int Urogynecol J"},{"key":"ref13","doi-asserted-by":"crossref","first-page":"909","DOI":"10.1007\/s00192-015-2909-0","article-title":"Is the levator-urethra gap helpful for diagnosing avulsion?","volume":"27","author":"H P Dietz","year":"2016","journal-title":"Int Urogynecol J"},{"key":"ref14","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1111\/j.1523-536X.2008.00222.x","article-title":"Tears in the vagina, perineum, sphincter ani, and rectum and first sexual\nintercourse after childbirth: a nationwide follow-up","volume":"35","author":"I Radestad","year":"2008","journal-title":"Birth"},{"key":"ref15","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1007\/s00737-017-0802-1","article-title":"Psychological consequences of pelvic floor trauma following vaginal birth: a\nqualitative study from two Australian tertiary maternity units","volume":"21","author":"E M Skinner","year":"2018","journal-title":"Arch Womens Ment Health"},{"key":"ref16","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1111\/ajo.12286","article-title":"Psychological and somatic sequelae of traumatic vaginal delivery: A literature\nreview","volume":"55","author":"E M Skinner","year":"2015","journal-title":"Aust N Z J Obstet Gynaecol"},{"key":"ref17","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1111\/j.1479-828X.2005.00363.x","article-title":"Pelvic floor trauma in childbirth \u2013 myth or reality?","volume":"45","author":"H P Dietz","year":"2005","journal-title":"Aust N Z J Obstet Gynaecol"},{"key":"ref18","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1016\/j.ejogrb.2003.09.047","article-title":"Influence of spontaneous and instrumental vaginal delivery on objective measures\nof pelvic organ support: assessment with the pelvic organ prolapse\nquantification (POPQ) technique and functional cine magnetic resonance\nimaging","volume":"115","author":"C Dannecker","year":"2004","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"ref19","doi-asserted-by":"crossref","first-page":"91: e1","DOI":"10.1016\/j.ajog.2009.03.028","article-title":"Fetal head circumference and length of second stage of labor are risk factors\nfor levator ani muscle injury, diagnosed by 3-dimensional transperineal\nultrasound in primiparous women","volume":"201","author":"D V Valsky","year":"2009","journal-title":"Am J Obstet Gynecol"},{"key":"ref20","doi-asserted-by":"crossref","first-page":"1037","DOI":"10.1111\/jog.12303","article-title":"Do we protect the pelvic floor with non-elective cesarean? A study of\n3-D\/4-D pelvic floor ultrasound immediately after delivery","volume":"40","author":"S Aydin","year":"2014","journal-title":"J Obstet Gynaecol Res"},{"key":"ref21","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1097\/01.AOG.0000194063.63206.1c","article-title":"Obstetric factors associated with levator ani muscle injury after vaginal\nbirth","volume":"107","author":"R Kearney","year":"2006","journal-title":"Obstet Gynecol"},{"key":"ref22","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1002\/uog.7563","article-title":"Three-dimensional ultrasound of the pelvic floor 2 days after first delivery:\ninfluence of constitutional and obstetric factors","volume":"35","author":"A Falkert","year":"2010","journal-title":"Ultrasound Obstet Gynecol"},{"key":"ref23","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1111\/aogs.13315","article-title":"Can pelvic floor trauma be predicted antenatally?","volume":"97","author":"J Caudwell-Hall","year":"2018","journal-title":"Acta Obstet Gynecol Scand"},{"key":"ref24","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1111\/aogs.13103","article-title":"Intrapartum predictors of maternal levator ani injury","volume":"96","author":"J Caudwell-Hall","year":"2017","journal-title":"Acta Obstet Gynecol Scand"},{"key":"ref25","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1002\/uog.12571","article-title":"Levator hematoma at the attachment zone as an early marker for levator ani\nmuscle avulsion","volume":"43","author":"K van Delft","year":"2014","journal-title":"Ultrasound Obstet Gynecol"},{"key":"ref26","doi-asserted-by":"crossref","first-page":"1223","DOI":"10.1111\/aogs.13660","article-title":"Reducing birth trauma by the implementation of novel monitoring and\ndocumentation tools","volume":"98","author":"N Kimmich","year":"2019","journal-title":"Acta Obstet Gynecol Scand"},{"key":"ref27","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1002\/uog.11190","article-title":"Diagnosis of levator avulsion injury: a comparison of three methods","volume":"40","author":"H P Dietz","year":"2012","journal-title":"Ultrasound Obstet Gynecol"},{"key":"ref28","doi-asserted-by":"crossref","first-page":"804","DOI":"10.1097\/AOG.0b013e3181d534cd","article-title":"The influence of pelvic muscle activation during vaginal delivery","volume":"115","author":"M P Parente","year":"2010","journal-title":"Obstet Gynecol"},{"key":"ref29","doi-asserted-by":"crossref","first-page":"1776","DOI":"10.1002\/nau.23175","article-title":"Evaluation of levator ani muscle throughout the different stages of labor by\ntransperineal 3D ultrasound","volume":"36","author":"J A Garcia Mejido","year":"2017","journal-title":"Neurourol Urodyn"}],"container-title":["Zeitschrift f\u00fcr Geburtshilfe und Neonatologie"],"original-title":[],"language":"de","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-1153-9387.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,4,19]],"date-time":"2021-04-19T22:39:56Z","timestamp":1618871996000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-1153-9387"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,5,7]]},"references-count":29,"journal-issue":{"issue":"02","published-online":{"date-parts":[[2021,4,19]]},"published-print":{"date-parts":[[2021,4]]}},"URL":"https:\/\/doi.org\/10.1055\/a-1153-9387","relation":{},"ISSN":["0948-2393","1439-1651"],"issn-type":[{"type":"print","value":"0948-2393"},{"type":"electronic","value":"1439-1651"}],"subject":[],"published":{"date-parts":[[2020,5,7]]}}}