scholarly journals A Simple, Reproducible and Low-cost Simulator for Teaching Surgical Techniques to Repair Obstetric Anal Sphincter Injuries

2018 ◽  
Vol 40 (08) ◽  
pp. 465-470 ◽  
Author(s):  
Roxana Knobel ◽  
Lia Volpato ◽  
Liliam Gervasi ◽  
Raquel Viergutz ◽  
Alberto Trapani
Keyword(s):  
Anal Sphincter ◽  
Low Cost ◽  
Internal Sphincter ◽  
Surgical Techniques ◽  
External Sphincter ◽  
Rectal Mucosa ◽  
Obstetric Anal Sphincter Injuries ◽  
Fourth Degree ◽  
Anatomy And Physiology ◽  
Application Techniques

Objective To describe and evaluate the use of a simple, low-cost, and reproducible simulator for teaching the repair of obstetric anal sphincter injuries (OASIS). Methods Twenty resident doctors in obstetrics and gynecology and four obstetricians participated in the simulation. A fourth-degree tear model was created using low-cost materials (condom simulating the rectal mucosa, cotton tissue simulating the internal anal sphincter, and bovine meat simulating the external anal sphincter). The simulator was initially assembled with the aid of anatomical photos to study the anatomy and meaning of each component of the model. The laceration was created and repaired, using end-to-end or overlapping application techniques. Results The model cost less than R$ 10.00 and was assembled without difficulty, which improved the knowledge of the participants of anatomy and physiology. The sutures of the layers (rectal mucosa, internal sphincter, and external sphincter) were performed in keeping with the surgical technique. All participants were satisfied with the simulation and felt it improved their knowledge and skills. Between 3 and 6 months after the training, 7 participants witnessed severe lacerations in their practice and reported that the simulation was useful for surgical correction. Conclusion The use of a simulator for repair training in OASIS is affordable (low-cost and easy to perform). The simulation seems to improve the knowledge and surgical skills necessary to repair severe lacerations. Further systematized studies should be performed for evaluation.

scholarly journals Risk Factors for Obstetric Anal Sphincter Injuries among Women Delivering at a Tertiary Hospital in Southwestern Uganda

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Mahad Ali ◽  
Richard Migisha ◽  
Joseph Ngonzi ◽  
Joy Muhumuza ◽  
Ronald Mayanja ◽  
...  
Keyword(s):  
Risk Factors ◽  
Vaginal Delivery ◽  
Anal Sphincter ◽  
Tertiary Hospital ◽  
Monthly Income ◽  
Obstetric Anal Sphincter Injuries ◽  
Perineal Tear ◽  
Fourth Degree ◽  
Anal Sphincter Injury ◽  
Second Stage Of Labour

Background. Obstetric anal sphincter injuries (OASIS) arise from perineal trauma during vaginal delivery and are associated with poor maternal health outcomes. Most OASIS occur in unattended deliveries in resource-limited settings. However, even in facilities where deliveries are attended by skilled personnel, a number of women still get OASIS. Objectives. To determine the incidence and risk factors for obstetric anal sphincter injuries among women delivering at Mbarara Regional Referral Hospital (MRRH). Methods. We conducted an unmatched hospital-based case control study, with the ratio of cases to controls of 1 : 2 (80 cases and 160 controls). We defined a case as a mother who got a third- or fourth-degree perineal tear after vaginal delivery while the controls recruited were the next two mothers who delivered vaginally without a third- or fourth-degree perineal tear. A questionnaire and participants’ medical records review were used to obtain sociodemographic and clinical data. We estimated the incidence of OASIS and performed univariable and multivariable logistic regression to identify the associated risk factors. Results. The cumulative incidence for OASIS during the study period was 6.6%. The risk factors for OASIS were 2nd stage of labour ≥1 hour (aOR 6.07, 95%CI 1.86–19.82, p=0.003), having episiotomy performed during labour (aOR 2.57, 95%CI 1.07–6.17, p=0.035), perineum support during delivery (aOR 0.03, 95%CI 0.01–0.12, p<0.001), and monthly income of >50,000 shillings (aOR 0.09, 95%CI 0.03–0.28, p<0.001). Conclusions and Recommendations. The risk factors for obstetric anal sphincter injury were prolonged second stage of labour and performing episiotomies during deliveries while higher monthly income and perineum support during delivery were protective. We recommend routine support to the perineum during delivery. Care should be taken in mothers with episiotomies, as they can extend and cause OASIS.

scholarly journals Evaluation of Suzor forceps training by studying obstetric anal sphincter injuries: a retrospective study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Perrine COSTE MAZEAU ◽  
Nedjma BOUKEFFA ◽  
Nathalie TICAUD BOILEAU ◽  
Samantha HUET ◽  
Maud TRAVERSE ◽  
...  
Keyword(s):  
Risk Factors ◽  
Body Mass Index ◽  
Retrospective Study ◽  
Observational Study ◽  
Anal Sphincter ◽  
University Hospital ◽  
Obstetric Anal Sphincter Injuries ◽  
Fourth Degree ◽  
Perineal Tears ◽  
Vacuum Extractor

Abstract Background Instrumental deliveries are an unavoidable part of obstetric practice. Dedicated training is needed for each instrument. To identify when a trainee resident can be entrusted with instrumental deliveries by Suzor forceps by studying obstetric anal sphincter injuries. Methods A French retrospective observational study of obstetric anal sphincter injuries due to Suzor forceps deliveries performed by trainee residents was conducted from November 2008 to November 2016 at Limoges University Hospital. Perineal lesion risk factors were studied. Sequential use of a vacuum extractor and then forceps was also analyzed. Results Twenty-one residents performed 1530 instrumental deliveries, which included 1164 (76.1%) using forceps and 89 (5.8%) with sequential use of a vacuum extractor and then forceps. Third and fourth degree perineal tears were diagnosed in 82 patients (6.5%). Residents caused fewer obstetric anal sphincter injuries after 23.82 (+/− 0.8) deliveries by forceps (p = 0.0041), or after 2.36 (+/− 0.7) semesters of obstetrical experience (p = 0.0007). No obese patient (body mass index> 30) presented obstetric anal sphincter injuries (p = 0.0013). There were significantly fewer obstetric anal sphincter injuries after performance of episiotomy (p <  0.0001), and more lesions in the case of the occipito-sacral position (p = 0.028). Analysis of sequential instrumentation did not find any additional associated risk. Conclusion Training in the use of Suzor forceps requires extended mentoring in order to reduce obstetric anal sphincter injuries. A stable level of competence was found after the execution of at least 24 forceps deliveries or after 3 semesters (18 months) of obstetrical experience.

Educational Modalities for Teaching Surgical Techniques for Obstetric Anal Sphincter Injuries

2020 ◽  
Vol 135 ◽  
pp. 73S
Author(s):  
Lindsey Jackson ◽  
John J. Byrne ◽  
Andrew Lupo ◽  
Maria Florian-Rodriguez ◽  
Clifford Wai ◽  
...  
Keyword(s):  
Anal Sphincter ◽  
Surgical Techniques ◽  
Obstetric Anal Sphincter Injuries

Changes in the Anal Sphincter with Age

1996 ◽  
Vol 37 (1P1) ◽  
pp. 357-361 ◽  
Author(s):  
M. B. Nielsen ◽  
J. F. Pedersen
Keyword(s):  
Anal Sphincter ◽  
Internal Sphincter ◽  
External Sphincter ◽  
Anal Endosonography ◽  
Sphincter Muscle ◽  
Normal Variation ◽  
Anorectal Disease ◽  
History Of ◽  
Age Range ◽  
Maximum Minimum

Purpose: To describe the changes in the endosonographic appearance of the anal sphincter muscles with age. Material and Methods: Fifty subjects (age range 22–85 years) with no history of anorectal disease or surgery were studied with anal endosonography. The thickness of the internal and external anal sphincter was registered and correlated to age. For the internal sphincter, which is often asymmetric, the maximum and minimum thicknesses were measured at any part of the circumference (except anteriorly for anatomic reasons) and also in the lateral positions. Results: A significant positive correlation with age was found for all maximum, minimum, and average internal sphincter thicknesses. Moreover, the echogenicity of the internal sphincter changed with age as the sphincter muscle became more echogenic. There was no significant correlation between external sphincter thickness and age. Conclusion: Knowledge of the normal variation of the internal sphincter thickness with age is important since endosonography may be used to identify patients with hypertrophy of the internal sphincter. Currently, we consider maximal thicknesses above 4 mm to be abnormal in patients under 50 years of age, whereas in patients aged at least 50 years thicknesses of 5 mm or more are considered abnormal.

Anal Sphincter Size Measured by Endosonography in Healthy Volunteers

1992 ◽  
Vol 33 (5) ◽  
pp. 453-456 ◽  
Author(s):  
M. B. Nielsen ◽  
C. Hauge ◽  
O. Ø. Rasmussen ◽  
M. Sørensen ◽  
J. F. Pedersen ◽  
...  
Keyword(s):  
Anal Sphincter ◽  
Anal Manometry ◽  
Internal Sphincter ◽  
External Sphincter ◽  
Muscle Thickness ◽  
Anal Endosonography ◽  
Puborectalis Muscle ◽  
Sphincter Muscle ◽  
Cross Sectional ◽  
Vaginal Deliveries

The anal sphincter muscles consist of the circular internal and external sphincters together with the sling-shaped associated puborectalis muscle. Ten men, 10 women with no vaginal deliveries, and 10 women with one or more vaginal deliveries were studied with anal endosonography using a 7 MHz multiplanar endoprobe. The thickness of the internal sphincter and the thickness, length, and cross-sectional area of the external sphincter were measured and related to age, sex, and parity. Reproducibility was assessed by similar measurements on different days in 10 volunteers. Anal sphincter size was the same in men and women and was not affected by the number of child births. Internal sphincter muscle thickness increased with age. Anal manometry and electromyography with an anal sponge were performed in all volunteers but the results did not correlate to any of the anal sphincter dimensions. Our conclusion is that although there are some limitations, endosonography can be used to determine the size of the anal sphincter muscles.

scholarly journals STRUCTURE OF THE ANAL CANAL AND ANAL SPHINCTER DOGS IN NORM AND AFTER PROCTECTOMY WITH BRINGING DOWN THE COLON

2015 ◽  
Vol 14 (6) ◽  
pp. 25-32
Author(s):  
S. R. Bashirov ◽  
M. N. Trifonov ◽  
A. A. Gaidash ◽  
V. I. Tikhonov
Keyword(s):  
Smooth Muscle ◽  
Clinical Practice ◽  
Anal Canal ◽  
Experimental Model ◽  
Anal Sphincter ◽  
Muscle Atrophy ◽  
Internal Sphincter ◽  
External Sphincter ◽  
Perianal Skin ◽  
Artificial Sphincter

With gistostereometry study the structure of the anal canal and anal sphincter dogs in norm and after proctectomy with bringing down the colon, forming neoanus and neosphinkter. The artificial sphincter is the inevitable process of smooth muscle atrophy can save at least half the volume of smooth muscle, similar to the number in the internal sphincter needed to restore function after holding involuntary proctectomy. Neoanus of mucous and submucosal colon relegated acquired typical smooth relief with the advent of the vertical pleats on the type of anal columns of Morgagni and with the perianal skin was closely associated with the subcutaneous portion of the external sphincter smooth muscle and an artificial sphincter. Thus, the experimental model of the internal sphincter and neoanus created by bringing down the mucous and the formation of smooth cuffs, very similar in quantitative and qualitative terms, the structure of the anal canal and anal sphincter dogs and can be used in clinical practice.

scholarly journals Diagnosis and Treatment of Obstetric Anal Sphincter Injuries: New Evidence and Perspectives

2021 ◽  
Vol 10 (15) ◽  
pp. 3261
Author(s):  
Antonino Spinelli ◽  
Virginia Laurenti ◽  
Francesco Maria Carrano ◽  
Enrique Gonzalez-Díaz ◽  
Katarzyna Borycka-Kiciak
Keyword(s):  
Early Diagnosis ◽  
Anal Sphincter ◽  
Clinical Examination ◽  
Therapeutic Strategy ◽  
Clinical Presentation ◽  
Late Onset ◽  
Obstetric Anal Sphincter Injuries ◽  
Fourth Degree ◽  
Perineal Tears ◽  
New Evidence

Perineal injury during childbirth is a common event with important morbidity associated in particular with third-and-fourth degree perineal tears (also referred to as obstetric anal sphincter injuries—OASIS). Early diagnosis of these damages is mandatory to define a prompt therapeutic strategy and thus avoid the development of late-onset consequences, such as faecal incontinence. For this purpose, various diagnostic exams can be performed after a thorough clinical examination. The management of OASIS includes several measures and should be individualized according to the timing and features of the clinical presentation.

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