{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T10:27:34Z","timestamp":1770719254121,"version":"3.49.0"},"reference-count":29,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2019,2,21]],"date-time":"2019-02-21T00:00:00Z","timestamp":1550707200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100008247","name":"University of Otago","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008247","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Aust NZ J Obst Gynaeco"],"published-print":{"date-parts":[[2019,8]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Levator ani muscle (<jats:styled-content style=\"fixed-case\">LAM<\/jats:styled-content>) and anal sphincter injuries are common after vaginal birth and are associated with pelvic organ prolapse and anal incontinence.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>Our objective was to investigate long\u2010term association between delivery mode, <jats:styled-content style=\"fixed-case\">LAM<\/jats:styled-content> avulsion and obstetric anal sphincter injuries (<jats:styled-content style=\"fixed-case\">OASIS<\/jats:styled-content>) in women at least 20\u00a0years after their first birth.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>All women recruited at \u2018index birth\u2019 of the Dunedin (New Zealand) arm of ProLong (<jats:styled-content style=\"fixed-case\">PRO<\/jats:styled-content>lapse and incontinence <jats:styled-content style=\"fixed-case\">LONG<\/jats:styled-content>\u2010term research) Study, were invited to have translabial and transperineal ultrasound assessment of <jats:styled-content style=\"fixed-case\">LAM<\/jats:styled-content> and anal sphincters. Post\u2010processing analysis of imaging data was performed blinded against delivery data. Statistical analysis was performed using the \u03c7<jats:sup>2<\/jats:sup> test and results are expressed as odds ratios (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the initial 1250 participants, 196 women returned for examination. Mean age was 50.8\u00a0years with a mean body mass index of 27.6 and median parity was three. They were seen on average 23\u00a0years after their first delivery. Four data sets were unavailable and one declined ultrasound assessment, leaving 191 for analysis. <jats:styled-content style=\"fixed-case\">LAM<\/jats:styled-content> avulsion was diagnosed in 29 (15.2%), and 24 women (12.6%) had significant anal sphincter defect. <jats:styled-content style=\"fixed-case\">LAM<\/jats:styled-content> avulsion was associated with forceps delivery (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 2.45, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.04\u20135.80, <jats:italic>P\u00a0<\/jats:italic>=<jats:italic>\u00a0<\/jats:italic>0.041). Forceps conveyed a greater risk of <jats:styled-content style=\"fixed-case\">OASIS<\/jats:styled-content> (21%) compared to a spontaneous vaginal delivery (11%) but did not reach statistical significance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Forceps delivery is associated with long\u2010term injurious effect on pelvic floor structures. Discussions of the long\u2010term negative impact of pelvic floor structures and their functions are necessary to achieve an informed consent toward an operative vaginal delivery.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ajo.12948","type":"journal-article","created":{"date-parts":[[2019,2,22]],"date-time":"2019-02-22T04:46:36Z","timestamp":1550810796000},"page":"590-596","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Delivery mode, levator avulsion and obstetric anal sphincter injury: A cross\u2010sectional study 20\u00a0years after childbirth"],"prefix":"10.1111","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5865-2392","authenticated-orcid":false,"given":"Sylvia","family":"Lin","sequence":"first","affiliation":[{"name":"Women's Health Waikato DHB  Hamilton New Zealand"},{"name":"Department of Obstetrics &amp; Gynaecology Faculty of Medical and Health Sciences University of Auckland  Auckland New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ixora Kamisan","family":"Atan","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynaecology &amp; Neonatology Sydney Medical School Nepean, The University of Sydney  Sydney New South Wales Australia"},{"name":"Department of Obstetrics &amp; Gynaecology Universiti Kebangsaan Malaysia Medical Centre  Kuala Lumpur Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2211-6149","authenticated-orcid":false,"given":"Hans Peter","family":"Dietz","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynaecology &amp; Neonatology Sydney Medical School Nepean, The University of Sydney  Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Herbison","sequence":"additional","affiliation":[{"name":"Department of Preventive and Social Medicine Dunedin School of Medicine University of Otago Dunedin New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter Donald","family":"Wilson","sequence":"additional","affiliation":[{"name":"Department of Women's and Children's Health Dunedin School of Medicine University of Otago  Dunedin New 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