ArticleAmerican journal of obstetrics and gynecology2019
Pelvic organ prolapse as a function of levator ani avulsion, hiatus size, and strength.
Article in American journal of obstetrics and gynecology, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 50 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
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
50 citing papers in PubMed, 3 syntheses or guidelines pooled it, 88 citations in OpenAlex.
- Management of levator ani avulsion: a systematic review and narrative synthesis.Archives of gynecology and obstetrics · 2023Pooled it
- Effect of exercise on female pelvic floor morphology and muscle function: a systematic review.International urogynecology journal · 2023Pooled it
- Investigating the association of the dimensions of genital hiatus and levator hiatus with pelvic organ prolapse: a systematic review.International urogynecology journal · 2021Pooled it
- Postpartum pelvic floor muscle training, levator ani avulsion and levator hiatus area: a randomized trial.International urogynecology journal · 2023Trial
- The Uncorrected Defect: A Risk Stratification Model for Persistent Levator Ballooning Following Pelvic Organ Prolapse Repair.International urogynecology journal · 2026Observational
- Levator hiatus area from 21 weeks' gestation to 8 years after first delivery according to vaginal parity: prospective cohort study with an 8-year recall extension.Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology · 2026Article
- Female pelvic floor protection-Where do we have to go?Acta obstetricia et gynecologica Scandinavica · 2026Review
- The Role of 3D/4D Transperineal Ultrasound in Risk Stratification for Pelvic Organ Prolapse Recurrence: Native Tissue Versus Mesh Repair.Journal of clinical medicine · 2026Article
- Artificial Intelligence for the Automated Measurement of Hiatal Dimensions.International urogynecology journal · 2026Observational
- Image-Quality Assessment of the Levator Ani Immediately After Delivery.International urogynecology journal · 2026Article
- Assessment of risk factors for pelvic organ prolapse using dynamic MRI combined with clinical data.Insights into imaging · 2026Article
- Prevalence and Risk Factors for Vaginal Flatus From Mid-Pregnancy to 12 Months Postpartum: A Longitudinal Cohort Study.BJOG : an international journal of obstetrics and gynaecology · 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
- The Levator Hiatus Area detected by 3D-TPUS as an indicator of rectal prolapse severity.International journal of colorectal disease · 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
- Association between neonatal birthweight and maternal vaginal wall prolapse: a retrospective analysis of postpartum women.Frontiers in medicine · 2026Article
- Chapter 4.5: New Proposed Treatments for Pelvic Organ Prolapse.International urogynecology journal · 2026Review
- Utilizing intelligent pelvic floor ultrasonography combined with real-time shear wave elastography for evaluating female pelvic floor functions.Quantitative imaging in medicine and surgery · 2025Article
- Women's experiences of life and healthcare after levator ani avulsion: a qualitative interview study.BMC women's health · 2025Article
- Impact of levator ani muscle avulsions on Manchester procedure outcomes: A 5-year follow-up study.Acta obstetricia et gynecologica Scandinavica · 2025Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors at 3 institutions in 2 countries.
Funding
Abstract
backgroundObstetrical levator ani muscle avulsion is detected after 10%-30% of vaginal deliveries and is associated with pelvic organ prolapse later in life. However, the mechanism by which levator avulsion may contribute to prolapse is unknown.
objectivesThis study investigated the extent by which size of the levator hiatus and pelvic muscle weakness may explain the association between levator avulsion and pelvic organ prolapse. STUDY
designThis was a supplementary study of a longitudinal cohort of parous women enrolled 5-10 years after first delivery and assessed annually for prolapse (defined as descent beyond the hymen) for up to 9 annual visits. For this substudy, vaginally parous participants were assessed for levator avulsion using 3-dimensional transperineal ultrasound. Ultrasound was performed at a median interval of 11 years from delivery. Ultrasound volumes also were used to measure levator hiatus area with Valsalva. Pelvic muscle strength was measured with perineometry. Women with and without pelvic organ prolapse were compared for levator avulsion, levator hiatus area, and pelvic muscle strength, using multivariable logistic regression yielding a measure of mediation. Bootstrap methods were used to calculate the confidence interval corresponding to the measure of mediation by hiatus area and pelvic muscle strength.
resultsProlapse was identified in 109 of 429 (25%) and was significantly associated with levator avulsion (odds ratio, 4.17; 95% confidence interval, 2.28-7.31). Prolapse also was associated with levator hiatus area (odds ratio, 1.52 per 5 cm
conclusionsThe strong association between pelvic organ prolapse and levator avulsion can be explained to a large extent by a larger levator hiatus and weaker pelvic muscles after levator avulsion.
Indexed as
Identifiers
What OpenQuestion holds
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.