{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T04:07:42Z","timestamp":1790482062858,"version":"4.1.0"},"reference-count":47,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2014,2,19]],"date-time":"2014-02-19T00:00:00Z","timestamp":1392768000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2014,8]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To establish the relationship between postpartum levator ani muscle (<jats:styled-content style=\"fixed-case\">LAM<\/jats:styled-content>) avulsion and signs and\/or symptoms of pelvic floor dysfunction (<jats:styled-content style=\"fixed-case\">PFD<\/jats:styled-content>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Observational longitudinal cohort study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>District General University Hospital, <jats:styled-content style=\"fixed-case\">UK<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population or sample<\/jats:title><jats:p>Primigravida at 36\u00a0weeks' gestation and 3\u00a0months postpartum.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Pelvic floor muscle strength (<jats:styled-content style=\"fixed-case\">PFMS<\/jats:styled-content>) and pelvic organ prolapse were assessed clinically using validated methods. Transperineal ultrasound was performed to identify <jats:styled-content style=\"fixed-case\">LAM<\/jats:styled-content> avulsion and measure hiatus dimensions. Validated questionnaires evaluated sexual function, urinary and faecal incontinence.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p><jats:styled-content style=\"fixed-case\">PFD<\/jats:styled-content> signs and symptoms related to <jats:styled-content style=\"fixed-case\">LAM<\/jats:styled-content> avulsion.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Two hundred and sixty nine primigravida without <jats:styled-content style=\"fixed-case\">LAM<\/jats:styled-content> avulsion participated and 71% (<jats:italic>n<\/jats:italic>\u00a0=\u00a0191) returned postpartum. <jats:styled-content style=\"fixed-case\">LAM<\/jats:styled-content> avulsion was found in 21% of vaginal deliveries (<jats:italic>n<\/jats:italic>\u00a0=\u00a030, 95%<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 15.1\u201328.4%). Women with minor and major avulsion had worse <jats:styled-content style=\"fixed-case\">PFMS<\/jats:styled-content> (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.038) and more anterior compartment prolapse (maximum stage 2; <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.024). Antenatal hiatus antero\u2010posterior diameter on ultrasound was significantly smaller in women sustaining avulsion (<jats:italic>P\u00a0<\/jats:italic>=\u00a00.011). Postnatal measurements were significantly increased following avulsion. Women with major avulsion were less sexually active at both antenatal and postnatal periods (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.030). These women had more postnatal urinary incontinence and symptoms such as reduced vaginal sensation and \u2018too loose vagina\u2019. No postnatal differences were found for faecal incontinence, prolapse symptoms or quality of life. The correlation of differences in variables was only slight\u2013fair with avulsion severity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Twenty one percent of women sustain <jats:styled-content style=\"fixed-case\">LAM<\/jats:styled-content> avulsion during their first vaginal delivery with significant impact on signs and symptoms of <jats:styled-content style=\"fixed-case\">PFD<\/jats:styled-content>. As avulsion has been described as the missing link in the development of prolapse; longer term follow\u2010up is vital.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.12666","type":"journal-article","created":{"date-parts":[[2014,2,19]],"date-time":"2014-02-19T07:22:47Z","timestamp":1392794567000},"page":"1164-1172","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":94,"title":["The relationship between postpartum levator ani muscle avulsion and signs and symptoms of pelvic floor dysfunction"],"prefix":"10.1111","volume":"121","author":[{"given":"K","family":"van Delft","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Urogynaecology Croydon University Hospital Croydon UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"AH","family":"Sultan","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Urogynaecology Croydon University Hospital 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