Objectives To determine the incidence of complete and partial levator ani muscle (LAM) lesions using 3‐dimensional endovaginal ultrasound (3D‐EVUS) at 3‐months postpartum in low‐risk primiparous women and evaluate associations with perineal outcomes and early urogynecological parameters. Methods Prospective interventional study of primiparous women with spontaneous vaginal delivery (March 2021–May 2023) at a tertiary urogynecology center in Rome, Italy (LATA protocol, IRB: 4202). Inclusion criteria: >37 weeks, age 18–45 years, body mass index (BMI) ≥20, physiologic pregnancy. Exclusion criteria: age >45, BMI 4500 g, forceps delivery. Perineal outcomes were recorded at delivery. Participants underwent 3D‐EVUS and urogynecological assessment evaluating pelvic floor muscle function, command inversion, recruitment of auxiliary muscles, and hypertonicity at 3‐months postpartum. LAM lesions were classified as partial (asymmetry, irregularity, ballooning) or complete/avulsion (detachment from pubic bone). Statistical analysis included logistic regression. Results Of 350 eligible patients, 202 completed follow‐up. At 3D‐EVUS, 52% had no LAM lesions, 45% had partial lesions, 3% had avulsions. Intact perineum was observed in 16.2% without LAM lesions, 4.4% with partial lesions, 0% with avulsion ( p = .018). Lacerations were more frequent with partial LAM lesions (73.6%) versus no lesion (59.0%) and avulsion (33.3%) ( p = .027). Command inversion was associated with LAM lesions ( p = .004). Urogenital hiatal area under Valsalva independently predicted LAM lesions ( p 20.8 cm 2 demonstrating 82% specificity and 45% sensitivity. Conclusions 3D‐EVUS enables the detection of subtle lesions frequently missed by conventional approaches. Partial LAM lesions are common in primiparous women after low‐risk delivery, while avulsions remain rare. Command inversion and enlarged urogenital area provide valuable markers for early detection and intervention.
Caramazza et al. (Mon,) studied this question.