Residual Defects of the Anal Sphincter Complex Following Primary Repair of Obstetrical Anal Sphincter Injuries at a Large Canadian Obstetrical Centre

Gold, Shira; Paquette, Joalee; Sobel, Mara; Alarab, May

doi:10.1016/j.jogc.2021.01.011

Cited by 7 publications

(2 citation statements)

References 16 publications

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“…For example, Gold et al reported a frequency of with no endosonographic evidence of tears in 31%, 28 This leads us to the association between defects and dyspareunia/perineal pain. Individuals with chronic pain are more likely to experience sexual dysfunction than those without.…”

Section: Discussionmentioning

confidence: 99%

“…Other studies reporting the results of 3D‐EAUS ≥ 3 months after the primary repair of OASI have had rather varying frequencies of defects. For example, Gold et al reported a frequency of 55%, with no endosonographic evidence of tears in 31%, 28 Okeahialam et al found a defect of >1 h (>30° angle) in 32%, 29 and Cerro et al described defects in 90% and found that the extent of a residual anal sphincter defect on 3D‐EAUS was the most relevant factor correlating with symptoms of anal incontinence 15 . Similarly, using transperineal ultrasound (TPUS), Hubka et al reported a defect prevalence of 13.6% in patients diagnosed with OASI, and Shek et al found defects in 40% of patients and associated them with significant symptoms of anal incontinence 16,30 .…”

Section: Discussionmentioning

confidence: 99%

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Sonographic postpartum anal sphincter defects and the association with pelvic floor pain and dyspareunia

Huber

Larsson

Lehmann

et al. 2023

Acta Obstet Gynecol Scand

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IntroductionPelvic floor pain and dyspareunia are both important entities of postpartum pelvic pain, often concomitant and associated with perineal tears during vaginal delivery. The association between postpartum sonographic anal sphincter defects, pelvic floor pain, and dyspareunia has not been fully established. We aimed to determine the prevalence of postpartum anal sphincter defects using three‐dimensional endoanal ultrasonography (3D‐EAUS) and evaluate their association with symptoms of pelvic floor pain and dyspareunia.Material and methodsThis prospective cohort study followed 239 primiparas from birth to 12 months post delivery. Anal sphincters were assessed with 3D‐EAUS 3 months postpartum, and self‐reported pelvic floor function data were obtained using a web‐based questionnaire distributed 1 year after delivery. Descriptive statistics were compared between the patients with and without sonographic defects, and the association between sonographic sphincter defects and outcomes were analyzed using logistic regression.ResultsAt 3 months postpartum, 48/239 (20%) patients had anal sphincter defects on 3D‐EAUS, of which 43 (18%) were not clinically diagnosed with obstetric anal sphincter injury at the time of delivery. Patients with sonographic defects had higher fetal weight than those without defects, and a perineum <2 cm before the suture was a risk factor for defects (odds ratio [OR], 6.9). Patients with sonographic defects had a higher frequency of dyspareunia (OR, 2.4), and pelvic floor pain (OR, 2.3) than those without defects.ConclusionsOur results suggest an association between postpartum sonographic anal sphincter defects, pelvic floor pain, and dyspareunia. A perineal height <2 cm, measured by bidigital palpation immediately postdelivery, was a risk factor for sonographic anal sphincter defect. We suggest offering pelvic floor sonography around 3 months postpartum to high‐ risk women to optimize diagnosis and treatment of perineal tears and include perineum <2 cm prior to primary repair as a proposed indication for postpartum follow‐up sonography.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Sonographic postpartum anal sphincter defects and the association with pelvic floor pain and dyspareunia

Huber

Larsson

Lehmann

et al. 2023

Acta Obstet Gynecol Scand

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Anal incontinence following obstetric anal sphincter injury: Is there a difference between subtypes? A systematic review

Zacchè

Ghosh

Liapis

et al. 2023

Neurourology and Urodynamics

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AimsObstetric anal sphincter injury (OASI) is associated with long‐term anal incontinence (AI). We aimed to address the following questions: (a) are women with major OASI (grade 3c and 4) at higher risk of developing AI when compared to women with minor OASI (grade 3a and 3b)? (b) is a fourth‐degree tear more likely to cause AI over a third‐degree tear?MethodsA systematic literature search from inception until September 2022. We considered prospective and retrospective cohort studies, cross‐sectional and case‐control studies without language restrictions. The quality was assessed by the Newcastle‐Ottawa Scale and the Joanna Briggs Institute critical appraisal checklist. Risk ratios (RRs) were calculated to measure the effect of different grades of OASI.ResultsOut of 22 studies, 8 were prospective cohort, 8 were retrospective cohort, and 6 were cross‐sectional studies. Length of follow‐up ranged from 1 month to 23 years, with the majority of the reports (n = 16) analysing data within 12‐months postpartum. Third‐degree tears evaluated were 6454 versus 764 fourth‐degree tears. The risk of bias was low in 3, medium in 14 and high in 5 studies, respectively. Prospective studies showed that major tears are associated with a twofold risk of AI for major tears versus minor tears, while retrospective studies consistently showed a risk of fecal incontinence (FI) which was two‐ to fourfold higher. Prospective studies showed a trend toward worsening AI symptoms for fourth‐degree tears, but this failed to reach statistical significance. Cross‐sectional studies with long‐term (≥5 years) follow‐up showed that women with fourth‐degree tear were more likely to develop AI, with an RR ranging from 1.4 to 2.2. Out of 3, 2 retrospective studies showed similar findings, but the follow‐up was significantly shorter (≤1 year). Contrasting results were noted for FI rates, as only 5 out of 10 studies supported an association between fourth‐degree tear and FI.ConclusionsMost studies investigate bowel symptoms within few months from delivery. Data heterogeneity hindered a meaningful synthesis. Prospective cohort studies with adequate power and long‐term follow‐up should be performed to evaluate the risk of AI for each OASI subtype.

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Correlation of anorectal symptoms and endoanal ultrasound findings after obstetric anal sphincter injuries (OASIS)

2023

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Residual Defects of the Anal Sphincter Complex Following Primary Repair of Obstetrical Anal Sphincter Injuries at a Large Canadian Obstetrical Centre

Cited by 7 publications

References 16 publications

Sonographic postpartum anal sphincter defects and the association with pelvic floor pain and dyspareunia

Sonographic postpartum anal sphincter defects and the association with pelvic floor pain and dyspareunia

Anal incontinence following obstetric anal sphincter injury: Is there a difference between subtypes? A systematic review

Correlation of anorectal symptoms and endoanal ultrasound findings after obstetric anal sphincter injuries (OASIS)

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