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The participants emptied their bladder before examination and a bladder volume of Epigenetics inhibitor Healthcare) by one investigator (IHB) blinded to clinical and background data. The pubovisceral muscle was defined as the most medial part of the levator ani complex bordering the LH. Ultrasound images were previewed and excluded from analysis unless the complete inner border of the pubovisceral muscle was visible in the axial plane. All analyses were conducted in the plane of minimal hiatal dimensions. To find the correct axial plane both the sagittal and the axial plane were simultaneous observed while the axial plane were rotated to find the plane with minimal distance between the hyperechogenic posterior aspect of the symphysis pubis and the hyperechogenic back sling of the pubovisceral muscle.[5, 26] LH area was defined as the area bordered by the pubovisceral muscle, symphysis pubis, and inferior pubic ramus in the axial plane (Fig. 2). Intraclass correlation coefficients (ICCs) for inter-[27] and intra-observer GUCY1B3 repeatability[28, 29] have been found to be were 0.92 and 0.56, respectively, for the 3D static volumes. The correlation learn more between ultrasound and MRI for LH area measurement was 0.9.[30] Pubovisceral muscle thickness was measured at rest in four different sites, with the mean used in the analyses (Fig. 2). ICCs for muscle thickness have been demonstrated to range from 0.13 to 0.70[27, 28]. Additionally, muscle thickness has been compared between ultrasound and magnetic resonance imaging (MRI), and a correlation coefficient of 0.8 for muscle thickness and 0.9 for LH area[30] were shown. Statistical analysis was performed using SPSS version 15. The relationships between muscle morphology and muscle strength, endurance and vaginal resting pressure were investigated using univariate linear logistic regressions models and Pearson product-moment correlation coefficient. Multiple regression is recommended when exploring predictive ability in a model when controlling for additional variables. This method was used to explore how well the variance in muscle thickness and LH area could be explained by manometry measurements (muscle strength, muscle endurance and resting pressure), after controlling for age, parity, body mass index (BMI) and socioeconomic status. The reason for choosing these control variables was that they have been found to be independently associated with POP.