Postpartum perineal wound infection and its effect on anal sphincter integrity: Results of a prospective observational study

Abstract

Introduction: Perineal wound infection can affect tissues at superficial, deep, and organ space levels. Women with obstetric anal sphincter injuries (OASIS) are at risk of infection; however, no study to date has investigated if infection can extend to affect the anal sphincter integrity. The aim of this study was to evaluate the clinical progression of perineal wound infection and its effect on the anal sphincter in women with or without OASIS using three-dimensional endoanal ultrasound (3D-EAUS). Material and methods: Women were recruited into the Prospective Observational Study Evaluating the Sonographic Appearance of the Anal Sphincter in Women With Perineal Wound Infection Following Vaginal Delivery (PERINEAL Study) between August 2020 and August 2021 (NCT 04480684). 3D-EAUS was performed weekly until complete wound healing. Significant bacterial colonization was diagnosed using the MolecuLight i:X camera. The primary study outcome was a change in a sphincter defect angle from baseline (wound infection) until wound healing. A robust Poisson regression model was used to analyze the effect of significant bacterial loads on the anal sphincter.Results: Seventy-three women were included. A median of two ultrasound scans were performed in each patient (range 1-16). Five women (6.8%) had an OASI clinically diagnosed at delivery. In total, 250 EAUS were performed. An external anal sphincter defect was found on EAUS in 55 (22.0%) scans (n = 10 women). An external anal sphincter and internal anal sphincter defect was found in 26 scans (10.4%) (n = 3 women). During the course of the wound healing process, there was no significant change in defect size in wounds with or without significant bacterial colonization. In cases of an intact anal sphincter, wound infection did not disrupt its integrity.

Obstetric anal sphincter injury in the second birth after perineal wound complication in the first birth: A nationwide register cohort study

“…However, a prospective cohort study found that ultrasound-evaluated integrity of the anal sphincter, up to 16 weeks postpartum, did not differ between women with and without perineal wound infection, indicating that this risk might be low. 24 The frequency of wound infection in the first vaginal birth reported here is low compared with other studies, 1,6 indicating a possible under-reporting of the condition and/or information bias. The outcome 'wound complication' was based on reported diagnoses at birth from the MBR and within 2 months postpartum from the Swedish Patient Register.…”

“…Occult OASI might be misclassified as ‘wound complication’, which would give a false association between wound complication and subsequent OASI, and therefore bias our results. However, a prospective cohort study found that ultrasound‐evaluated integrity of the anal sphincter, up to 16 weeks postpartum, did not differ between women with and without perineal wound infection, indicating that this risk might be low 24 …”

Quality of life in benign colorectal disease—a review of the assessment with the Gastrointestinal Quality of Life Index (GIQLI)

“…This implicates the need for therapeutic decision making and often psychologic support [ 1 , 2 , 40 , 48 ]. An accurate diagnostic assessment is needed, followed by an interdisciplinary exchange of information and an optimal selection of patients for surgical therapy, if this opens an option for improvement [ 1 , 2 , 30 , 49 – 51 ]. Several reports demonstrate improvements in QOL by surgical therapy of chronic diverticulitis, fecal incontinence, and constipation [ 30 , 49 , 50 ].…”