Comparing the diagnostic accuracy of 3 ultrasound modalities for diagnosing obstetric anal sphincter injuries

Taithongchai, Annika; Gruting, Isabelle M.A. van; Volløyhaug, Ingrid; Arendsen, Linda; Sultan, Abdul H.; Thakar, Ranee

doi:10.1016/j.ajog.2019.04.009

Cited by 42 publications

(50 citation statements)

References 28 publications

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“…All study participants gave written informed consent. The current study is a sub-analysis of a study assessing test accuracy of IUS and TPUS compared with EAUS for diagnosis of anal sphincter defects, and a power calculation of this parent study showed that 250 women were needed [17].…”

Section: Methodsmentioning

confidence: 99%

“…The IUS and TPUS volumes were analysed using tomographic ultrasound imaging (TUI; Fig. 2) [17]. The IAS and EAS were analysed using the same TUI, where the interval between the slices was adjusted according to the individual length of the EAS.…”

Section: Methodsmentioning

confidence: 99%

“…Alternatively, the anal sphincters can be examined with introital (IUS) and transperineal ultrasound (TPUS) using an endovaginal or abdominal probe [13][14][15][16]. In contrast to endoanal probes, endovaginal and abdominal probes are available in most obstetric and gynaecological units, and the examination is associated with less discomfort [17]. Previous studies have reported high inter-rater reliability [15] and strong correlation between AI and diagnosis of EAS defects on TPUS among urogynaecological patients [18,19].…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, the presenting symptoms of the patient depend on the muscle that is injured [20]. Two previous studies found that injury diagnosed with EAUS had a stronger correlation with total AI symptom scores than IUS and TPUS [16,17], but more detailed analyses of EAS and IAS defects in association with urgency, solid, liquid and flatal incontinence have not been carried out. Some studies have examined the association between anal canal pressures, AI and sphincter defects [4,6,11,21,22].…”

Section: Introductionmentioning

confidence: 99%

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Is endoanal, introital or transperineal ultrasound diagnosis of sphincter defects more strongly associated with anal incontinence?

et al. 2020

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Introduction and hypothesis Our aim was to explore the association between anal incontinence (AI) and persistent anal sphincter defects diagnosed with 3D endoanal (EAUS), introital (IUS) and transperineal ultrasound (TPUS) in women after obstetric anal sphincter injury (OASI) and study the association between sphincter defects and anal pressure. Methods We carried out a cross-sectional study of 250 women with OASI recruited during the period 2013-2015. They were examined 6-12 weeks postpartum or in a subsequent pregnancy with 3D EAUS, IUS and TPUS and measurement of anal pressure. Prevalence of urgency/solid/liquid AI or flatal AI and anal pressure were compared in women with a defect and those with an intact sphincter (diagnosed off-line) using Chi-squared and Mann-Whitney U test. Results At a mean of 23.6 (SD 30.1) months after OASI, more women with defect than those with intact sphincters on EAUS had AI; urgency/solid/liquid AI vs external defect: 36% vs 13% and flatal AI vs internal defect: 27% vs 13%, p < 0.05. On TPUS, more women with defect sphincters had flatal AI: 32% vs 13%, p = 0.03. No difference was found on IUS. Difference between defect and intact sphincters on EAUS, IUS and TPUS respectively was found for mean [SD] maximum anal resting pressure (48 [13] vs 55 [14] mmHg; 48 [12] vs 56 [13] mmHg; 50 [13] vs 54 [14] mmHg) and squeeze incremental pressure (33 [17] vs 49 [28] mmHg; 37 [23] vs 50 [28] mmHg; 36 [18] vs 50 [30] mmHg; p < 0.01). Conclusions Endoanal ultrasound had the strongest association with AI symptoms 2 years after OASI. Sphincter defects detected using all ultrasound methods were associated with lower anal pressure.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Is endoanal, introital or transperineal ultrasound diagnosis of sphincter defects more strongly associated with anal incontinence?

et al. 2020

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“…Endoanal ultralyd er ansett som den mest pålitelige metoden for å påvise skade på analsfinkterne, men transperineal ultralyd har også vist seg å vaere godt egnet til å utelukke skade (29). Imidlertid bør funn ved transperineal ultralyd alltid bekreftes med endoanal ultralyd, da førstnevnte har lav positiv prediktiv verdi sammenliknet med sistnevnte (30)(31)(32). Fordelen med transperineal ultralyd er at utstyret er lettere tilgjengelig enn det som brukes ved endoanal ultralyd.…”

Section: Diskusjonunclassified

Oppfølging ved skader av analsfinkter etter fødsel

Berg¹,

Sahlin²

2020

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Assessing Obstetric Anal Sphincter Injuries

Zhao

Tang³

et al. 2023

J of Ultrasound Medicine

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ObjectivesTo explore the differences in assessing obstetric anal sphincter injuries (OASI) between transperineal ultrasound (TPUS) and endoanal ultrasound (EAUS) and test relationships between ultrasound findings and anal incontinence (AI) symptoms.MethodsA group of 196 women with a history of vaginal delivery was recruited. OASI was detected in a set of 5 slices by EAUS and 8 slices by TPUS. OASI grading was performed on TPUS rules and EAUS rules. A “significant sphincter defect” was diagnosed by TPUS and EAUS using “2/3 rules.” Symptoms of AI were determined using the St Mark's Incontinence Score (SMIS). Ultrasound findings were compared between the two methods and correlated with symptoms.ResultsOf 196 women, 29 (14.8%) suffered from AI with a mean SMIS of 12.1 ± 4.5, and 70 (35.7%) women with a mean age of 57 years had suspected OASI on imaging. Twenty‐one (10.7%) “significant defects” were diagnosed by TPUS and 24 (12.2%) by EAUS. OASI Grades on TPUS had good agreement with EAUS rules (k = 0.70, P < .001). Logistic regression analysis showed that OASI Grade on imaging and “significant sphincter defects” seen on both forms of imaging were associated with AI symptoms. The odds ratio was 46 and 38 for “significant defects” on TPUS and EAUS, and 14 and 7 for OASI 3b+ on TPUS and EAUS in predicting AI, respectively.Conclusions“Significant defects” diagnosed by EAUS or TPUS and OASI Grade 3b+ predict AI symptoms. The diagnostic performance of endoanal and exoanal ultrasound (EAUS and TPUS) appear to be very similar.

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Comparing the diagnostic accuracy of 3 ultrasound modalities for diagnosing obstetric anal sphincter injuries

Abstract: Comparing the diagnostic accuracy of three ultrasound modalities for diagnosing obstetric anal sphincter injuries

Cited by 42 publications

References 28 publications

Is endoanal, introital or transperineal ultrasound diagnosis of sphincter defects more strongly associated with anal incontinence?

Is endoanal, introital or transperineal ultrasound diagnosis of sphincter defects more strongly associated with anal incontinence?

Oppfølging ved skader av analsfinkter etter fødsel

Assessing Obstetric Anal Sphincter Injuries

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