SynthesisInternational urogynecology journal2019
Delivery mode and the risk of levator muscle avulsion: a meta-analysis.
Synthesis in International urogynecology journal, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
27 citing papers in PubMed, 2 syntheses or guidelines pooled it, 74 citations in OpenAlex.
- Obstetric risk factors for anorectal dysfunction after delivery: a systematic review and meta-analysis.International urogynecology journal · 2021Pooled it
- Pregnancy, labour and delivery as risk factors for pelvic organ prolapse: a systematic review.International urogynecology journal · 2021Pooled it
- Episiotomy in vacuum extraction, do we cut the levator ani muscle? A prospective cohort study.International urogynecology journal · 2022Trial
- Obstetric Factors Associated with Pelvic Floor Disorders and Surgery 30 Years After Childbirth: A Prospective Cohort Study.International urogynecology journal · 2026Article
- Levator Ani Muscle Avulsion After Soft Cup Vacuum-Assisted Versus Spontaneous Vaginal Delivery: A 3D Transperineal Ultrasound Study.International urogynecology journal · 2026Article
- The pelvic floor dysfunction: Where obstetrics meets urogynecology.Acta obstetricia et gynecologica Scandinavica · 2026Article
- The Evolution of Pelvic Floor Ultrasound: From Urinary Incontinence and Pelvic Organ Prolapse to Maternal Birth Trauma, Levator Avulsion and Anal Sphincter Tears.International urogynecology journal · 2026Review
- Impact of delivery mode on diastasis recti abdominis, pelvic floor muscle function, and quality of life in early postpartum women: a cross-sectional study.Frontiers in medicine · 2026Article
- Association Between Mode of Delivery and Levator Ani Muscle Abnormalities on 4D Transperineal Ultrasound at 6 Weeks Postpartum.International journal of women's health · 2026Article
- The pelvic floor during pregnancy and delivery: Can pelvic floor trauma and disorders be prevented?Acta obstetricia et gynecologica Scandinavica · 2024Article
- Evaluation of levator ani muscle elasticity after vaginal delivery and cesarean section using shear wave elastography.Journal of medical ultrasonics (2001) · 2024Article
- Ultrasound examination of the pelvic floor during active labor: A longitudinal cohort study.Acta obstetricia et gynecologica Scandinavica · 2023Article
- Three-dimensional endovaginal ultrasound assessment using the levator ani deficiency score in primiparas: A replication study.Acta obstetricia et gynecologica Scandinavica · 2023Article
- An International Continence Society (ICS)/ International Urogynecological Association (IUGA) joint report on the terminology for the assessment and management of obstetric pelvic floor disorders.International urogynecology journal · 2023Article
- Is urethral pressure associated with parity and delivery mode?International urogynecology journal · 2022Article
- Birthweight difference between deliveries and the risk of obstetric anal sphincter injury in parous women.International urogynecology journal · 2022Article
- Faecal incontinence in adults.Nature reviews. Disease primers · 2022Review
- International Urogynecological Consultation (IUC): pathophysiology of pelvic organ prolapse (POP).International urogynecology journal · 2022Review
- Pelvic floor assessment using magnetic resonance imaging after vaginal delivery and elective caesarean delivery.International urogynecology journal · 2021Article
- Injury-associated levator ani muscle and anal sphincter ooedema following vaginal birth: a secondary analysis of the EMRLD study.BJOG : an international journal of obstetrics and gynaecology · 2021Observational
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors at 1 institution in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introduction and hypothesisFemale pelvic organ prolapse (POP) is a common condition, with a lifetime risk for surgery of 10-20%. Pregnancy and childbirth are the commonest modifiable risk factors for POP, and avulsion of the levator ani muscle is likely to be an etiological factor. Avulsion is more common in instrumental delivery. However, we were unable to identify a meta-analysis on this issue. Our aim was to perform a systemic review and quantitative meta-analysis of the prevalence of avulsion relative to delivery mode.
methodsFour electronic databases (MEDLINE, PubMed, Embase, and Google Scholar) were searched for studies published between 1991 and 1 October 2018 without language restrictions.
resultsTwenty studies met inclusion criteria, and 14 were prospective. Seventeen used sonographic techniques; three were magnetic resonance (MR) studies. For this review, three comparisons were performed: forceps vs. vacuum (9 studies), forceps vs. normal vaginal delivery (NVD) (12 studies), and vacuum vs. NVD (12 studies). The first meta-analysis showed an increased risk for avulsion following forceps compared with vacuum, with an odds ratio (OR) of 4.57 and confidence interval (CI) 3.21-6.51, p < 0.001. The second showed an increased risk for avulsion following forceps compared with NVD, with an OR of 6.94 (4.93-9.78), p < 0.001. The third showed no significant increased risk for avulsion following vacuum compared with NVD, with an OR of 1.31 (1.00-1.72), p = 0.051.
conclusionsForceps is a strong risk factor for avulsion, with an OR of 6.94 (4.93-9.78) compared with NVD and an OR of 4.57 (3.21-6.51) compared with vacuum birth.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.