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

Abstract

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.

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

“…This present study formed part of an interdisciplinary project involving birth‐related perineal injuries, endoanal ultrasonography, and postpartum pelvic floor disorders, and was a follow‐up to a cohort of the aforementioned projects 18 . Eligible for study inclusion were primiparous patients who delivered vaginally at >34 weeks during the project period (January 2016–January 2018).…”

“…This present study formed part of an interdisciplinary project involving birth‐related perineal injuries, endoanal ultrasonography, and postpartum pelvic floor disorders, and was a follow‐up to a cohort of the aforementioned projects. 18 Eligible for study inclusion were primiparous patients who delivered vaginally at >34 weeks during the project period (January 2016–January 2018). The study had a prospective cohort design and was conducted in the Department of Obstetrics and Gynecology of Östersund Hospital, where approximately 1300 women deliver each year.…”

The impact of maternal body mass index on pelvic floor during labor and after childbirth, and a new anesthetic approach for repair of perineal lacerations

“…Our research group has explored the rationale that a thin perineal body, represented by a short AVD, means that tissues are stretched or lacking. It has previously been shown that a short/thin perineal body, identified by palpation or transperineal ultrasound after delivery is associated with a higher degree of perineal/anal laceration during vaginal delivery 44,45 . It has been concluded that imaging diagnostics using different ultrasound methods in the acute phase does not add any more information for identifying a rupture in the external sphincter than the manual examination performed by the midwife and the physician 30 .…”

A sensorised surgical glove to improve training and detection of obstetric anal sphincter injury: A preclinical study on a pig model

“…10 There are conflicting studies on the utility of immediate postpartum EAUS to aid initial diagnosis of perineal trauma prior to repair. 11,12 One randomised control trial of 752 women who were randomised to routine examination or immediate EAUS found that EUAS before perineal repair may reduce rates of severe anal incontinence. 13 In contrast, another study reported that nearly 20% of scans performed immediately postpartum were 'non-assessable' due to poor image quality, and were difficult to perform on labour ward due to staff inexperience.…”