Postpartum ultrasound for the diagnosis of obstetrical anal sphincter injury

Bellussi, Federica; Dietz, Hans Peter

doi:10.1016/j.ajogmf.2021.100421

Cited by 11 publications

(14 citation statements)

References 42 publications

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“…Clinical injury is reported in approximately 5% of primiparous women 2 . Adding ultrasonography to standard clinical examination revealed a 12%–35% prevalence of occult or missed injuries, indicating diagnostic difficulties 3–6 . The routine in maternity units is an inspection of vagina and perineum and digital rectal palpation performed by the responsible accoucheur.…”

Section: Introductionmentioning

confidence: 99%

“…2 Adding ultrasonography to standard clinical examination revealed a 12%-35% prevalence of occult or missed injuries, indicating diagnostic difficulties. [3][4][5][6] The routine in maternity units is an inspection of vagina and perineum and digital rectal palpation performed by the responsible accoucheur. The incidence of OASI is higher in studies where perineal tears are re-examined by a second person.…”

Section: Introductionmentioning

confidence: 99%

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Use of endoanal ultrasound in detecting obstetric anal sphincter injury immediately after birth

Huber

Larsson

Harrysson

et al. 2023

Acta Obstet Gynecol Scand

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Introduction Obstetric anal sphincter injury (OASI) complicates around 5% of deliveries in primiparas. The study objective was to assess the utility of three‐dimensional endoanal ultrasonography (3D‐EAUS) in the diagnosis of OASI. Material and methods The present study was designed to mirror screening settings with an unselected cohort of nulliparous women. All enrolled patients underwent clinical examination of the perineum by the caregiver, and 3D‐EAUS was conducted. Post‐processing of ultrasonography volume data was performed by an experienced colorectal surgeon who was blinded to all other data. The sensitivity, specificity, negative predictive value, and positive predictive value of 3D‐EAUS in the diagnosis of OASI was evaluated. The trial is registered at ISCRTN: 18006769. Results A total of 680 scans were performed, of which 18.5% were judged as “non‐assessable”, resulting in 554 assessable recordings. Sphincter defects were observed in 12.8% of all assessable recordings on 3D‐EAUS (n = 71). With clinical examination set as the reference standard, ultrasound sensitivity in the diagnosis of OASI was 30.4%, whereas its specificity was 87.9%. The negative predictive value was 96.7% and the positive predictive value was only 9.9%. Comments were left on 175 examinations, of which 74% referred to the management of the examination. Conclusions Using 3D‐EAUS in a maternity ward is demanding because staff generally have little experience in endoanal ultrasound, which contributes to difficulties in obtaining good image quality. When 3D‐EAUS is performed to mirror screening settings, it adds no convincing diagnostic power to clinical examination in the diagnosis of OASI.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Use of endoanal ultrasound in detecting obstetric anal sphincter injury immediately after birth

Huber

Larsson

Harrysson

et al. 2023

Acta Obstet Gynecol Scand

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“…Contrast enemas and magnetic resonance imaging (MRI) are commonly used to evaluate anorectal anatomy in these cases. Transrectal ultrasonography (TRUS) is used as a diagnostic tool in adults in disorders including anorectal tumors, prostate cancer, anorectal disease in patients with inflammatory bowel disease (IBD) and anal sphincter evaluation in child-bearing females with postpartum fecal incontinence ( 1 , 2 ). Combined with other modalities such as anorectal manometry and pudendal nerve latency, TRUS helps correlate ultrasonography findings with sphincter function ( 3 ).…”

Section: Introductionmentioning

confidence: 99%

Anal Sphincter Defect and Fecal Incontinence

et al. 2022

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Anal sphincter defects can lead to fecal incontinence. The relationship between the extent of defect and continence is controversial. Magnetic resonance imaging (MRI) of the pelvis can assess anal sphincter defects. Transrectal ultrasonography (TRUS) is used to assess sphincter integrity in adults. We present a 17-year-old male with history of sexual abuse, rectal prolapse, and fecal incontinence. MRI showed a small defect that did not explain his clinical presentation. TRUS identified more extensive defects which were not picked up by MRI. The patient had rectopexy, and his rectal prolapse and fecal incontinence resolved. TRUS was superior in identifying sphincter defects compared with MRI. Our case also highlights that continence is possible despite large sphincter defects in pediatric patients. This may reflect the compensatory mechanism of residual sphincter in the absence of the aggravating factors like rectal prolapse.

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“…Imaging modalities are widely used for evaluation of obstetrical trauma. [15][16][17][18][19][20] Such studies focus on assessing injury to the anal sphincter and the levator ani muscles. Imaging might also be used in evaluation of perineal trauma, which may assist in establishing preventive measures for anal sphincter injury and in feedback to labor ward staff.…”

Section: Introductionmentioning

confidence: 99%

“…Imaging modalities are widely used for evaluation of obstetrical trauma 15–20 . Such studies focus on assessing injury to the anal sphincter and the levator ani muscles.…”

Section: Introductionmentioning

confidence: 99%

Assessment of Perineal Scars on Translabial Pelvic Floor Ultrasound: A Pilot Study

Housmans

Gillor

Shek

et al. 2022

J of Ultrasound Medicine

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Objective We aimed to describe a method for identifying and evaluating perineal scars using translabial pelvic floor ultrasound. We hypothesized that translabial ultrasound can identify a perineal scar and can differentiate episiotomies from spontaneous tears. Methods This pilot study is a secondary analysis of data obtained in the Epi‐No® trial. Perineal integrity was assessed using volumes acquired on pelvic floor muscle contraction according to the method previously described for anal sphincter imaging. A scar was diagnosed if a hypoechoic distortion in the perineum was noted. We postulated that an episiotomy would result in a linear scar visible on four dimensional translabial ultrasound whereas nonlinear scars were considered the result of spontaneous perineal tear of grade 2 or higher. The results of this assessment were compared with data retrieved from electronic medical records. Results A scar was identified in 79/120 women (66%): 42 (35%) linear and 37 (31%) nonlinear. Sonographic and clinical diagnosis agreed on the presence or absence of perineal trauma in 66%. Agreement for the type of laceration was 50%. Conclusion In this retrospective pilot study, a blinded assessment of translabial ultrasound volume data showed agreement between clinical data and sonographic assessment of perineal integrity in 66% and of type of laceration in 50%. More work is needed to optimize the method in assessment of perineal scars to improve its performance before it can be used in clinical audit and research.

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Postpartum ultrasound for the diagnosis of obstetrical anal sphincter injury

Cited by 11 publications

References 42 publications

Use of endoanal ultrasound in detecting obstetric anal sphincter injury immediately after birth

Use of endoanal ultrasound in detecting obstetric anal sphincter injury immediately after birth

Anal Sphincter Defect and Fecal Incontinence

Assessment of Perineal Scars on Translabial Pelvic Floor Ultrasound: A Pilot Study

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