{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T09:33:47Z","timestamp":1784626427979,"version":"3.55.0"},"reference-count":28,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2021,6,7]],"date-time":"2021-06-07T00:00:00Z","timestamp":1623024000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["R21 HD049818"],"award-info":[{"award-number":["R21 HD049818"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["P50 HD044406 002"],"award-info":[{"award-number":["P50 HD044406 002"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To determine whether all three components of the levator ani muscle (pubovisceral [= pubococcygeal], puborectal and iliococcygeal) and the external anal sphincter are equally affected by oedema associated with muscle injury after vaginal birth.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Observational cross\u2010sectional study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Michigan Medicine, University of Michigan.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>Primiparous women classified as high risk for levator ani muscle injury during childbirth.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>MRI scans obtained 6\u20138\u00a0weeks postpartum were analysed. Muscle oedema was assessed on axial and coronal fluid\u2010sensitive magnetic resonance (MRI) scans. Presence of oedema was separately determined in each levator ani muscle component and in the external anal sphincter for all subjects. Descriptive statistics and correlation with obstetric variables were obtained.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Oedema score on fluid\u2010sensitive MRI scans.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 78 women included in this cohort, 51.3% (<jats:italic>n<\/jats:italic>\u00a0=\u00a040\/78) showed muscle oedema in the pubovisceral (one bilateral avulsion excluded), 5.1% (<jats:italic>n<\/jats:italic>\u00a0=\u00a04\/78) in the puborectal and 5.1% (<jats:italic>n<\/jats:italic>\u00a0=\u00a04\/78) in the iliococcygeal muscle. No subject showed definite oedema on external anal sphincter. Incidence of oedema on the pubovisceral muscle was seven times higher than on any of the other analysed muscles (all paired comparisons, <jats:italic>P<\/jats:italic> &lt;\u00a00.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Even in the absence of muscle tearing, the pubovisceral muscle shows by far the highest incidence of injury, establishing that levator components are not equally affected by childbirth. External anal sphincter did not show oedema\u2014even in women with sphincter laceration\u2014 suggesting a different injury mechanism. Developing a databased map of injured areas helps understand injury mechanisms that can guide us in honing research on treatment and prevention.<\/jats:p><\/jats:sec><jats:sec><jats:title>Tweetable abstract<\/jats:title><jats:p>Injury\u2010associated levator ani muscle and anal sphincter oedema mapping on MRI reveals vulnerable muscle components after childbirth.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.16760","type":"journal-article","created":{"date-parts":[[2021,5,20]],"date-time":"2021-05-20T08:34:33Z","timestamp":1621499673000},"page":"2046-2053","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Injury\u2010associated levator ani muscle and anal sphincter ooedema following vaginal birth: a secondary analysis of the EMRLD study"],"prefix":"10.1111","volume":"128","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5134-8523","authenticated-orcid":false,"given":"F","family":"Pipitone","sequence":"first","affiliation":[{"name":"Pelvic Floor Research Group Michigan Medicine University of Michigan 1540 E Hospital Dr Ann Arbor MI 48109 USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"JM","family":"Miller","sequence":"additional","affiliation":[{"name":"University of Michigan School of Nursing and Medical School Department of Obstetrics and Gynecology 426 N Ingalls St Ann Arbor MI 48104 USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"JOL","family":"DeLancey","sequence":"additional","affiliation":[{"name":"Pelvic Floor Research Group Michigan Medicine University of Michigan 1540 E Hospital Dr Ann Arbor MI 48109 USA"},{"name":"Obstetrics and Gynecology Department Michigan Medicine University of Michigan 1540 E Hospital Dr Ann Arbor MI 48109 USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,6,7]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000178779.62181.01"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-018-3827-8"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2019.03.004"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-012-2118-z"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.09.3508"},{"key":"e_1_2_8_7_1","volume-title":"Terminologia Anatomica","author":"International Federation of Associations of Anatomists","year":"2013"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000109207.22354.65"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-014-2395-9"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2015.05.001"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000194063.63206.1c"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.9082"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13244-012-0190-z"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000214952.28605.e8"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-007-0388-7"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-006-0224-5"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2017.07.007"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/SPV.0000000000000872"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0029-7844(97)00682-0"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/nau.20957"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40477-013-0019-8"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000128906.61529.6b"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199312233292601"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-015-2747-0"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF01648831"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(84)90766-9"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1113\/jphysiol.1995.sp020980"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2006.10.894"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-011-1527-8"}],"container-title":["BJOG: An International Journal of Obstetrics &amp; 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