ArticleObstetrics and gynecology2015
Comparison of levator ani muscle avulsion injury after forceps-assisted and vacuum-assisted vaginal childbirth.
Article in Obstetrics and gynecology, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 2 of them syntheses that pooled it.
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The trial behind it
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Who cites it
22 citing papers in PubMed, 2 syntheses or guidelines pooled it, 70 citations in OpenAlex.
- Hyaluronidase for reducing perineal trauma.The Cochrane database of systematic reviews · 2024Pooled it
- Delivery mode and the risk of levator muscle avulsion: a meta-analysis.International urogynecology journal · 2019Pooled it
- The usual suspect: cross-sectional study of fundal pressure at second stage of delivery and the association with pelvic floor damage.International urogynecology journal · 2021Trial
- Levator Ani Muscle Avulsion After Soft Cup Vacuum-Assisted Versus Spontaneous Vaginal Delivery: A 3D Transperineal Ultrasound Study.International urogynecology journal · 2026Article
- Forceps-Assisted Delivery Could Reduce the Iatrogenic Fistula Crisis: A Clinical Commentary.International urogynecology journal · 2026Article
- Transperineal combined two- and three-dimensional ultrasound evaluation of the effects of different delivery methods on levator ani muscles and pelvic organ prolapse.Quantitative imaging in medicine and surgery · 2025Article
- Establishment and validation of a clinical prediction model for predicting early postpartum pelvic floor muscle weakness among primiparous women after vaginal delivery: a retrospective study.Frontiers in medicine · 2025Article
- Pelvic floor injury during vaginal birth is life-altering and preventable: what can we do about it?American journal of obstetrics and gynecology · 2024Review
- Validation of a built-in software in automatically reconstructing the tomographic images of the levator ani muscle.International urogynecology journal · 2024Article
- Gestational diabetes mellitus and pelvic floor function 6 weeks postpartum in Chinese women.International urogynecology journal · 2023Article
- Hiatal failure: effects of pregnancy, delivery, and pelvic floor disorders on level III factors.International urogynecology journal · 2023Review
- Influence of Different Obstetric Factors on Early Postpartum Pelvic Floor Function in Primiparas After Vaginal Delivery.International journal of women's health · 2023Article
- Effects of Oxytocin for Induction and Augmentation of Labor on Pelvic Floor Symptoms and Support in the Postpartum Period.Female pelvic medicine & reconstructive surgery · 2021Article
- Defining "normal recovery" of pelvic floor function and appearance in a high-risk vaginal delivery cohort.International urogynecology journal · 2020Article
- The effect of the first vaginal birth on pelvic floor anatomy and dysfunction.International urogynecology journal · 2019Observational
- Exosomes secreted by urine-derived stem cells improve stress urinary incontinence by promoting repair of pubococcygeus muscle injury in rats.Stem cell research & therapy · 2019Article
- The practical value of levator ani muscle injury repair.Techniques in coloproctology · 2019Article
- Correlation Between Delivery Mode and Pelvic Organ Prolapse Evaluated by Four-Dimensional Pelvic Floor Ultrasonography.Medical science monitor : international medical journal of experimental and clinical research · 2018Article
- Can pelvic floor dysfunction after vaginal birth be prevented?International urogynecology journal · 2016Article
- The Epidemiology of Pelvic Floor Disorders and Childbirth: An Update.Obstetrics and gynecology clinics of North America · 2016Review
Corrections and comments
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Authors and funding
6 authors at 1 institution in 1 country.
Funding
Abstract
objectiveUsing three-dimensional transperineal ultrasonography, we compared the prevalence of levator ani muscle injury after forceps with vacuum-assisted vaginal delivery.
methodsThis was a retrospective cohort study. Women who experienced at least one forceps delivery (across all deliveries) were compared with women who had at least one vacuum birth. On average, participants were 10 years from the index delivery. Three-dimensional transperineal ultrasound volumes were captured as cine loops at rest with Valsalva and with pelvic floor muscle contraction. The primary outcome was levator ani muscle avulsion. Secondary outcomes included hiatal diameter and area. Prevalence of pelvic floor disorders was also compared between the two delivery groups.
resultsAmong 45 participants in the forceps group and 28 participants in the vacuum group, there were no differences between groups in maternal age at first delivery, parity, body mass index, birth weight, episiotomy, or duration of second stage. History of anal sphincter laceration was more common in the forceps group. The prevalence of levator ani muscle avulsion was significantly higher after forceps compared with vacuum delivery (22/45 [49%] compared with 5/28 [18%], P=.012, prevalence ratio 2.74, 95% confidence interval [CI] 1.17-6.40, odds ratio 4.40 [95% CI 1.42-13.62]). Controlling for delivery type, levator ani muscle avulsion was associated with symptoms of prolapse (P=.036), although objective evidence of prolapse was not significantly different between groups (P=.20).
conclusionTen years after delivery, the prevalence of levator avulsion is almost tripled after forceps compared with vacuum-assisted vaginal delivery. LEVEL OF EVIDENCE: II.
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