Observational studyBJOG : an international journal of obstetrics and gynaecology2021
Injury-associated levator ani muscle and anal sphincter ooedema following vaginal birth: a secondary analysis of the EMRLD study.
Observational study in BJOG : an international journal of obstetrics and gynaecology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed, 15 citations in OpenAlex.
- 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
- Assessing Postpartum Levator Ani Muscle Recovery: A Feasibility Study on Automated Texture Analysis in Transvaginal Ultrasound.Ultrasound in medicine & biology · 2025Article
- Magnetomyographic assessment of pelvic floor muscles compared to ultrasound during pregnancy.Physiological reports · 2025Article
- Two minutes is sufficient to characterize the viscoelastic properties of the human lower birth canal during the first stage of labor.Clinical biomechanics (Bristol, Avon) · 2025Article
- Correlation between albumin levels during the third trimester and the risk of postpartum levator ani muscle rupture.Open medicine (Warsaw, Poland) · 2025Article
- Extrauterine Causes of Severe and Concealed Postpartum Bleeding: Clinical Aspects and Challenges.Maternal-fetal medicine (Wolters Kluwer Health, Inc.) · 2024Article
- A model to predict delivery time following induction of labor at term with a dinoprostone vaginal insert: a retrospective study.Irish journal of medical science · 2024Observational
- Pelvic floor injury during vaginal birth is life-altering and preventable: what can we do about it?American journal of obstetrics and gynecology · 2024Review
- Article
- Association between infant birthweight and pelvic floor muscle strength: a population-based cohort study.BMC pregnancy and childbirth · 2023Article
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Authors and funding
3 authors at 2 institutions in 1 country.
Funding
Abstract
objectiveTo determine whether all three components of the levator ani muscle (pubovisceral [= pubococcygeal], puborectal and iliococcygeal) and the external anal sphincter are equally affected by oedema associated with muscle injury after vaginal birth.
designObservational cross-sectional study.
settingMichigan Medicine, University of Michigan. POPULATION: Primiparous women classified as high risk for levator ani muscle injury during childbirth.
methodMRI scans obtained 6-8 weeks postpartum were analysed. Muscle oedema was assessed on axial and coronal fluid-sensitive magnetic resonance (MRI) scans. Presence of oedema was separately determined in each levator ani muscle component and in the external anal sphincter for all subjects. Descriptive statistics and correlation with obstetric variables were obtained.
main outcome measuresOedema score on fluid-sensitive MRI scans.
resultsOf the 78 women included in this cohort, 51.3% (n = 40/78) showed muscle oedema in the pubovisceral (one bilateral avulsion excluded), 5.1% (n = 4/78) in the puborectal and 5.1% (n = 4/78) in the iliococcygeal muscle. No subject showed definite oedema on external anal sphincter. Incidence of oedema on the pubovisceral muscle was seven times higher than on any of the other analysed muscles (all paired comparisons, P < 0.001).
conclusionsEven in the absence of muscle tearing, the pubovisceral muscle shows by far the highest incidence of injury, establishing that levator components are not equally affected by childbirth. External anal sphincter did not show oedema-even in women with sphincter laceration- suggesting a different injury mechanism. Developing a databased map of injured areas helps understand injury mechanisms that can guide us in honing research on treatment and prevention. TWEETABLE ABSTRACT: Injury-associated levator ani muscle and anal sphincter oedema mapping on MRI reveals vulnerable muscle components after childbirth.
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