ReviewInternational urogynecology journal2023
Hiatal failure: effects of pregnancy, delivery, and pelvic floor disorders on level III factors.
Review in International urogynecology journal, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers.
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
19 citing papers in PubMed.
- IUGA International Guidelines on Obstetric Anal Sphincter Injuries.International urogynecology journal · 2026Article
- Urogenital Hiatus Closure System: A Framework for Understanding how Muscle, Motor Control, and Fascial Connections Interact in Normal and Failed Closure.International urogynecology journal · 2026Review
- Pelvic floor morphofunctional characteristics in female rugby players beyond the tackle. Pelvic floor muscles in high-impact sports.Scientific reports · 2026Article
- Perineoplasty, Pain, and Urinary Retention Following Native Tissue Vaginal Prolapse Surgery.International urogynecology journal · 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
- Chapter 4.5: New Proposed Treatments for Pelvic Organ Prolapse.International urogynecology journal · 2026Review
- Influence of induction of labor on morphological alterations in the pelvic floor after vaginal delivery determined by 4D transperineal ultrasound.BMC medical imaging · 2025Article
- Urogenital Hiatus Closure: Facts, Fallacies, and Why a Unified Theory of Hiatal Failure is Needed.International urogynecology journal · 2025Article
- Hiatus and pelvic floor failure patterns in pelvic organ prolapse: a 3D MRI study of structural interactions using a level III conceptual model.American journal of obstetrics and gynecology · 2025Article
- Racial differences in the levator ani muscle and levator hiatus in individuals of reproductive age.American journal of obstetrics and gynecology · 2025Article
- High and low take-off external prolapse phenotypes can be characterised preoperatively on defaecation proctography.Techniques in coloproctology · 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
- Up for the tackle? The pelvic floor and rugby. A review.European journal of sport science · 2024Review
- Improving radiological quantification of levator hiatus features with measures informed by statistical shape modeling.Journal of medical imaging (Bellingham, Wash.) · 2024Article
- A unified pelvic floor conceptual model for studying morphological changes with prolapse, age, and parity.American journal of obstetrics and gynecology · 2024Review
- Pelvic floor injury during vaginal birth is life-altering and preventable: what can we do about it?American journal of obstetrics and gynecology · 2024Review
- Functional Anatomy of Urogenital Hiatus Closure: the Perineal Complex Triad Hypothesis.International urogynecology journal · 2024Article
- Significance of Pelvic Floor Hiatus in Female Pelvic Organ Prolapse.Journal of medical ultrasoundReview
- Update on Diagnosis and Treatment for Levator Avulsion.Journal of medical ultrasoundReview
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors.
Funding
Abstract
introduction and hypothesisThe failure of the levator hiatus (LH) and urogenital hiatus (UGH) to remain closed is not only associated with pelvic floor disorders, but also contributes to recurrence after surgical repair. Pregnancy and vaginal birth are key events affecting this closure. An understanding of normal and failed hiatal closure is necessary to understand, manage, and prevent pelvic floor disorders.
methodsThis narrative review was conducted by applying the keywords "levator hiatus" OR "genital hiatus" OR "urogenital hiatus" in PubMed. Articles that reported hiatal size related to pelvic floor disorders and pregnancy were chosen. Weighted averages for hiatal size were calculated for each clinical situation.
resultsWomen with prolapse have a 22% and 30% larger LH area measured by ultrasound at rest and during Valsalva than parous women with normal support. Women with persistently enlarged UGH have 2-3 times higher postoperative failure rates after surgery for prolapse. During pregnancy, the LH area at Valsalva increases by 29% from the first to the third trimester in preparation for childbirth. The enlarged postpartum hiatus recovers over time, but does not return to nulliparous size after vaginal birth. Levator muscle injury during vaginal birth, especially forceps-assisted, is associated with increases in hiatal size; however, it only explains a portion of hiatus variation-the rest can be explained by pelvic muscle function and possibly injury to other level III structures.
conclusionsFailed hiatal closure is strongly related to pelvic floor disorders. Vaginal birth and levator injury are primary factors affecting this important mechanism.
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.