Postpartum two‐ and three‐dimensional ultrasound evaluation of anal sphincter complex in women with obstetric anal sphincter injury

Ros, Cristina; Franco, Eva Martínez; Woźniak, Magdalena; Cassadó, Jordi; Santoro, G. A.; Elias, N.; López, Marta; Palacio, Montse; Wieczorek, Paweł; Espuña‐Pons, Montserrat

doi:10.1002/uog.15924

Cited by 42 publications

(26 citation statements)

References 39 publications

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“…Contrary to Ros et al, we also found a weak significant association between TPUS score and Wexner score. Our results revealed that it was the EAS score rather than the IAS score, for both EAUS and TPUS, that constituted the body of correlation.…”

Section: Discussioncontrasting

confidence: 99%

“…In concordance with Ros et al, our coefficients of correlation between EAUS and TPUS were almost identical, with a correlation coefficient of 0.72 vs 0.76 for defects in the EAS and 0.66 vs 0.65 for defects in the IAS.…”

Section: Discussionsupporting

confidence: 92%

“…We found a significant but weak association between EAUS score and Wexner score, similar to the findings of Ros et al and Starck et al . Our correlation coefficients were again almost identical to those of Starck regarding the correlation between EAUS score and Wexner, with a correlation coefficient of 0.36 and 0.39.…”

Section: Discussionsupporting

confidence: 91%

“…The body of literature comparing EAUS and TPUS in detecting OASIS is sparse, but growing, and concludes that high‐resolution TPUS has good tissue discrimination and correlates well to the ultrasound findings found by EAUS.…”

Section: Introductionmentioning

confidence: 97%

“…4 Recently, very good repeatability in detecting OASIS with TPUS, regardless of experience, has been shown. 7 The body of literature comparing EAUS and TPUS in detecting OASIS is sparse, but growing, [8][9][10] and concludes that high-resolution TPUS has good tissue discrimination and correlates well to the ultrasound findings found by EAUS.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of transperineal and endoanal ultrasound in detecting residual obstetric anal sphincter injury

Stuart

Ignell

Örnö

2019

Acta Obstet Gynecol Scand

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Introduction Endoanal ultrasound is considered the gold standard when assessing the obstetric anal sphincter complex. Due to its relative intrusiveness and economic cost, other ultrasound modalities are on the rise, such as transperineal ultrasound with a convex probe. The aim of our study was to evaluate the agreement between endoanal ultrasound scores (EAUS score) and transperineal ultrasound scores (TPUS score) in assessing residual obstetric anal sphincter defects. Material and methods Fifty‐nine women were examined 6 months after primary suturing of obstetric anal sphincter injury with two ultrasound modalities. A standardized scoring system analyzing the length, depth and radial extent of both the external (EAS) and internal (IAS) sphincter was used. Wexner fecal incontinence score was used to assess the patients’ symptoms. Results Transperineal ultrasound scores score showed a strong significant correlation with EAUS score during both pelvic floor relaxation and contraction: Spearman's rho [rs] = 0.74, P < 0.001, and rs = 0.77, P < 0.001, respectively. For both EAS and IAS, significant correlations were found for all parameters, that is, length, depth and angle between both EAUS and TPUS. A statistically significant correlation was found between EAUS score and Wexner score (rs = 0.36, P = 0.005). A significant correlation between the EAS‐EAUS score (rs = 0.36, P = 0.005) and Wexner score was found, but no significance was found between IAS‐EAUS score and Wexner score (rs = 0.22, P = 0.097). Significant correlations were found for Wexner score and TPUS score in resting state (rs = 0.36, P = 0.01) and contracting state (rs = 0.28, P < 0.05), and between Wexner score and EAS‐TPUS score in resting state (rs = 0.32, P = 0.02). Conclusions The results indicated a strong agreement between endoanal and transperineal ultrasound in assessing residual obstetric anal sphincter defects 6 months after primary suturing. Furthermore, a weak significant correlation was found between the ultrasound scores and the patients’ Wexner fecal incontinence score.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

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Comparison of transperineal and endoanal ultrasound in detecting residual obstetric anal sphincter injury

Stuart

Ignell

Örnö

2019

Acta Obstet Gynecol Scand

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Exoanal Imaging of the Anal Sphincters

Dietz

2017

J of Ultrasound Medicine

122

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Since its introduction in the early 1990s, endoanal sonography has become the mainstay of morphologic assessment of the anal canal and sphincter, especially for obstetric anal sphincter trauma. Lack of availability of suitable systems and the invasive nature of the method have limited uptake and clinical utility. More recently, exoanal or transperineal/translabial tomographic imaging has been developed as a noninvasive alternative. This pictorial overview aims to introduce the reader to this new diagnostic modality and to demonstrate common findings in asymptomatic and symptomatic women.

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Three‐Dimensional Transperineal Ultrasound Assessment of the Anal Sphincter Immediately After Vaginal Birth

Cattani,

Packet,

Samešova

et al. 2024

J of Ultrasound Medicine

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ObjectivesTo assess the feasibility of acquiring adequate transperineal ultrasound (TPUS) volumes of the anal sphincter (AS) immediately after vaginal birth, the reproducibility of its measurements, and detecting defects therein.MethodsSecondary analysis of TPUS volumes of the AS, acquired immediately after vaginal birth with a transversely oriented convex probe. Two independent experts ranked off‐line image quality as “inadequate,” “adequate,” or “ideal” using the Point‐of‐Care Ultrasound Image Quality scale. On “adequate” and “ideal” quality volumes, the length of the external AS at 6 and 12 o'clock, and the volume of the external and internal AS were measured. Additionally, volumes were screened for AS defects on tomographic ultrasound imaging. Subsequently, we rated the intra‐ and interrater agreement on those findings.ResultsOf 183 volumes, 162 were considered “adequate” or of “ideal” quality (88.5%). Reasons for “inadequacy” were shadow artifacts (16/21), poor resolution (3/21), incomplete acquisition (1/21), or aberrant AS morphology (1/21). The intrarater reliability of two‐dimensional (2D) and three‐dimensional (3D) measurements was excellent, whereas interrater reliability was fair to good for 2D measurements and good for 3D measurements. In those tomographic ultrasound imaging (TUI) sequences including AS defects, the intra‐ and interrater reliability of the defect measurement were excellent [intraclass correlation coefficient (ICC) = 0.92 (0.80–0.94)] and moderate [ICC = 0.72 (0.63–0.79)]. In this cohort, there were only few (4/48; 8.3%) AS defects. However, grading them was poorly reproducible between experts.ConclusionTPUS of the AS immediately after vaginal birth yields adequate image quality and allows for reproducible measurements. In the few patients with AS defects, there was good agreement on the presence, but it was poor for the extent of defects.

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Postpartum two‐ and three‐dimensional ultrasound evaluation of anal sphincter complex in women with obstetric anal sphincter injury

Cited by 42 publications

References 39 publications

Comparison of transperineal and endoanal ultrasound in detecting residual obstetric anal sphincter injury

Comparison of transperineal and endoanal ultrasound in detecting residual obstetric anal sphincter injury

Exoanal Imaging of the Anal Sphincters

Three‐Dimensional Transperineal Ultrasound Assessment of the Anal Sphincter Immediately After Vaginal Birth

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