{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T17:34:35Z","timestamp":1779298475596,"version":"3.51.4"},"reference-count":39,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2018,3,5]],"date-time":"2018-03-05T00:00:00Z","timestamp":1520208000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Albert S. McKern Foundation"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2018,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Levator trauma is a risk factor for the development of pelvic organ prolapse. We aimed to identify antenatal predictors for significant damage to the levator ani muscle during a first vaginal delivery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and methods<\/jats:title><jats:p>A retrospective observational study utilizing data from two studies with identical inclusion criteria and assessment protocols between 2005 and 2014. A total of 1148 primiparae with an uncomplicated singleton pregnancy were recruited and assessed with translabial ultrasound at 36 weeks antepartum and 871 (76%) returned for reassessment 3\u20136 months postpartum. The ultrasound data of vaginally parous women were analyzed for levator avulsion and microtrauma. The former was diagnosed if the muscle insertion at the inferior pubic ramus in the plane of minimal hiatal dimensions and within 5 mm above were abnormal on tomographic ultrasound imaging. Microtrauma was diagnosed in women with an intact levator and if there was a postpartum increase in hiatal area on Valsalva by &gt;20% with the resultant area \u226525 cm<jats:sup>2<\/jats:sup>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The complete datasets of 844 women were analyzed. Among them, 609 delivered vaginally: by normal vaginal delivery in 452 (54%), a vacuum birth in 102 (12%) and a forceps delivery in 55 (6%). Levator avulsion was diagnosed in 98 and microtrauma in 97. On multivariate analysis, increasing maternal age, lower body mass index and lower bladder neck descent were associated with avulsion. Increased bladder neck descent and a family history of cesarean section (<jats:styled-content style=\"fixed-case\">CS<\/jats:styled-content>) were associcated with microtrauma.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Maternal age, body mass index, bladder neck descent and family history of <jats:styled-content style=\"fixed-case\">CS<\/jats:styled-content> are antenatal predictors for levator trauma.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.13315","type":"journal-article","created":{"date-parts":[[2018,2,2]],"date-time":"2018-02-02T13:02:43Z","timestamp":1517576563000},"page":"751-757","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":34,"title":["Can pelvic floor trauma be predicted antenatally?"],"prefix":"10.1111","volume":"97","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6554-4576","authenticated-orcid":false,"given":"Jessica","family":"Caudwell\u2010Hall","sequence":"first","affiliation":[{"name":"Sydney Medical School Nepean University of Sydney Nepean Hospital Penrith NSW Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ixora","family":"Kamisan Atan","sequence":"additional","affiliation":[{"name":"Sydney Medical School Nepean University of Sydney Nepean Hospital Penrith NSW Australia"},{"name":"Universiti Kebangsaan Malaysia Medical Center Kuala Lumpur Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chris","family":"Brown","sequence":"additional","affiliation":[{"name":"NHMRC Clinical Trials Center University of Sydney Sydney NSW Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0647-1797","authenticated-orcid":false,"given":"Rodrigo","family":"Guzman Rojas","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics Cl\u00ednica Alemana de Santiago\u2010Universidad del Desarrollo Santiago Chile"},{"name":"Department of Obstetrics and Gynecology Hospital Cl\u00ednico de la Universidad de Chile Santiago Chile"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3085-6489","authenticated-orcid":false,"given":"Susanne","family":"Langer","sequence":"additional","affiliation":[{"name":"Sydney Medical School Nepean University of Sydney Nepean Hospital Penrith NSW Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ka L.","family":"Shek","sequence":"additional","affiliation":[{"name":"Sydney Medical School Nepean University of Sydney Nepean Hospital Penrith NSW Australia"},{"name":"Liverpool Clinical School Western Sydney University Sydney NSW Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hans P.","family":"Dietz","sequence":"additional","affiliation":[{"name":"Sydney Medical School Nepean University of Sydney Nepean Hospital Penrith NSW Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,3,5]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1701-2163(16)30081-0"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.11141"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.13924"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2010.02704.x"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2008.01751.x"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000178779.62181.01"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0412.2011.01315.x"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000109207.22354.65"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.14856"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.12920"},{"key":"e_1_2_7_12_1","first-page":"S46","article-title":"It's the first vaginal birth that does most of the damage","volume":"26","author":"Kamisan Atan I","year":"2015","journal-title":"Int Urogynecol J"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2010.07.046"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajo.12171"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e3181c2ce96"},{"key":"e_1_2_7_16_1","unstructured":"Australian Bureau of Statistics.Population Projections Australia 2012 (base) to 2101[Internet]. 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