{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T22:55:49Z","timestamp":1791327349848,"version":"4.3.1"},"reference-count":34,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2014,12,17]],"date-time":"2014-12-17T00:00:00Z","timestamp":1418774400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"National Research Ethics Service South West London committee","award":["REC10\/H0806\/87"],"award-info":[{"award-number":["REC10\/H0806\/87"]}]},{"name":"Mayday Childbirth Charity Fund"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2015,8]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To explore the natural history of levator avulsion in primipara 1\u00a0year postpartum and correlate this to 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:p><\/jats:sec><jats:sec><jats:title>Population or sample<\/jats:title><jats:p>Nullipara at 36\u00a0weeks of gestation, 3\u00a0months and 1\u00a0year postpartum.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Validated methods assessed muscle strength, prolapse, ultrasound measurements of levator hiatus and avulsion, and questionnaires for sexual function, and urinary and anal incontinence. Pattern differences over time were evaluated using linear mixed models.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Natural history of levator avulsion and relationship with <jats:styled-content style=\"fixed-case\">PFD<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 269 nullipara, 191 returned at 3\u00a0months and 147 (55%) at 1\u00a0year postpartum; 109 had a vaginal delivery and 38 had a caesarean delivery. Sixty\u2010two percent (<jats:italic>n<\/jats:italic>\u00a0=\u00a013\/21; 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 41\u201379%) of levator avulsions diagnosed 3\u00a0months postpartum were no longer evident at 1\u00a0year. Following vaginal delivery, nine women (8%, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 4.2\u201315.1%) had persistent levator avulsion. Most changes in <jats:styled-content style=\"fixed-case\">PFD<\/jats:styled-content> occurred between the antenatal and first postnatal visit, without improvement at 1\u00a0year. Women with persistent levator avulsion had significantly worse deterioration patterns of muscle strength, hiatus measurements and vaginal symptoms (loose vagina\/lump sensation). However, evidence of <jats:styled-content style=\"fixed-case\">PFD<\/jats:styled-content> was also related to no longer evident levator avulsion.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Sixty\u2010two percent of levator avulsions were no longer evident 1\u00a0year postpartum. Partial avulsion has a tendency to improve over time, which seems to be less common for complete levator avulsions. Women with no longer evident and persistent levator avulsion had <jats:styled-content style=\"fixed-case\">PFD<\/jats:styled-content>, with worse patterns in presence of persistent avulsion.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.13223","type":"journal-article","created":{"date-parts":[[2014,12,17]],"date-time":"2014-12-17T06:50:04Z","timestamp":1418799004000},"page":"1266-1273","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":72,"title":["The natural history of levator avulsion one year following childbirth: a prospective study"],"prefix":"10.1111","volume":"122","author":[{"given":"KWM","family":"van Delft","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Urogynaecology Croydon University Hospital Croydon UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R","family":"Thakar","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, 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