{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T16:25:03Z","timestamp":1785515103329,"version":"3.56.0"},"reference-count":38,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2024,12,3]],"date-time":"2024-12-03T00:00:00Z","timestamp":1733184000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2024,12,3]],"date-time":"2024-12-03T00:00:00Z","timestamp":1733184000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100007687","name":"Svenska L\u00e4kares\u00e4llskapet","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100007687","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100023670","name":"Nyckelfonden","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100023670","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100009228","name":"Region \u00d6rebro l\u00e4n","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100009228","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>First, to assess whether levator ani deficiency (LAD) is associated with pelvic floor dysfunction 1\u2009year postpartum, including urinary, vaginal and bowel symptoms; and second, to explore at what cut\u2010off of LAD score such pelvic floor dysfunction arises.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Nested case\u2013control study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>\u00d6rebro University Hospital, \u00d6rebro, Sweden.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Population or Sample<\/jats:title>\n                    <jats:p>Primiparous women 1\u2009year after vaginal birth.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Three\u2010dimensional endovaginal ultrasound assessment of the levator ani muscle; LAD score based on this ultrasound, and validated questions about pelvic floor dysfunction. Logistic regression models were used.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcome Measures<\/jats:title>\n                    <jats:p>Symptoms of pelvic floor dysfunction associated with LAD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Altogether 190 women were included, 103 of whom were symptomatic cases and 87 asymptomatic controls. 53% in the case group, and 58% in the control group had a LAD score of 0. A greater LAD score was significantly associated with urinary incontinence (adjusted odds ratio [aOR] 1.11, 95% confidence interval [CI] 1.00\u20131.22) and vaginal laxity (aOR 1.14, 95% CI 1.03\u20131.25). The risk of urinary incontinence was increased when the LAD cut\u2010off score was set between \u2265\u20091 point and \u2265\u20094 points. The risk of vaginal laxity was increased when the cut\u2010off was set between \u2265\u20098 and\u2009\u2265\u200914 points.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>LAD was associated with both urinary incontinence and vaginal laxity. The risk of urinary incontinence increased already with minor LAD and defects of the most medial levator ani muscle portions normally supporting the midurethra may explain this increase.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1471-0528.18036","type":"journal-article","created":{"date-parts":[[2024,12,3]],"date-time":"2024-12-03T03:00:45Z","timestamp":1733194845000},"page":"596-605","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Levator Ani Deficiency and Pelvic Floor Dysfunction 1\u2009Year Postpartum: A Prospective Nested Case\u2013Control Study"],"prefix":"10.1111","volume":"132","author":[{"given":"Markus Harry","family":"Jansson","sequence":"first","affiliation":[{"name":"Department of Clinical Sciences Danderyd Hospital, Karolinska Institute  Stockholm Sweden"},{"name":"School of Medical Sciences, Faculty of Health and Medicine \u00d6rebro University  \u00d6rebro Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophia","family":"Brismar Wendel","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences Danderyd Hospital, Karolinska Institute  Stockholm Sweden"},{"name":"Department of Obstetrics and Gynaecology Danderyd Hospital  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2529-9390","authenticated-orcid":false,"given":"Emilia","family":"Rotstein","sequence":"additional","affiliation":[{"name":"Department of Clinical Science, Intervention and Technology Karolinska Institute  Stockholm Sweden"},{"name":"Karolinska Pelvic Floor Centre, Department of Gynaecology and Reproductive Medicine Karolinska University Hospital  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,12,3]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e3181aa2c89"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000214952.28605.e8"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000128906.61529.6b"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.11080"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/nau.22944"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e31828ce97d"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.3951"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-013-2286-5"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.14633"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-014-2503-x"},{"key":"e_1_2_11_12_1","volume-title":"Prioritisation of Research Questions About Maternal Birth Injuries","author":"Swedish Agency for Health Technology Assessment and Assessment of Social Services, SBU","year":"2019"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2019.03.004"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.13223"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-014-2331-z"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.16009"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-013-2278-5"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-020-03447-0"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.14275"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-021-05029-w"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.14614"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2004.06.008"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0412.2011.01085.x"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-010-1243-9"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-021-05010-7"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-022-05397-x"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-020-03070-z"},{"key":"e_1_2_11_28_1","unstructured":"S. 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