scholarly journals Can transperineal ultrasound improve the diagnosis of obstetric anal sphincter injuries?

2021 ◽  
Author(s):  
Ka Wong ◽  
Ranee Thakar ◽  
Abdul Sultan ◽  
Vasanth Andrews
Keyword(s):  
Anal Sphincter ◽  
Clinical Examination ◽  
District General Hospital ◽  
Transperineal Ultrasound ◽  
Obstetric Anal Sphincter Injuries ◽  
Sphincter Defect ◽  
Research Fellow ◽  
Anal Sphincter Injury ◽  
Increased Risk ◽  
Anal Sphincter Defect

Background: Women with missed Obstetric anal sphincter injuries (OASIs) are at an increased risk of anal incontinence. Objective: To assess the accuracy of 3D Transperineal Ultrasound (TPUS) compared with clinical examination for detecting OASIs. Design: Prospective Observational longitudinal cohort study. Setting: District General Hospital, UK. Population or sample: Women undergoing their first vaginal delivery immediately postpartum. Methods: Perineal trauma was initially assessed by accouchers and women were then re-examined by a trained research fellow. A 3D TPUS was performed immediately after delivery before suturing to look for OASIs. Main outcome measures: OASIs on clinical examination and on TPUS Main Results: Two hundred and sixty-four women participated and two hundred and twenty-six (86%) delivered vaginally. Twenty-one (9%) sustained OASIs. Six (29%) of these tears were missed by the accoucher but were identified by the trained research fellow. TPUS identified 19 of the 21 (90.5%) OASIs. One percent (n = 2) had sonographic appearances of an anal sphincter defect and were not seen clinically. The positive and negative predictive of TPUS to detect OASIs were 91% and 99% respectively. TPUS identified 91% of OASIs compared to 71% detected by the accoucher. However, this was not statistically significant. Conclusions: More OASIs were identified on TPUS compared to examination. TPUS may have role in improving the detection rate of OASIs. Considering immense training and financial implications of using TPUS, attention needs to be focused on training to accurately identify anal sphincter defects on clinical examination. Funding:none Keywords: transperineal ultrasound imaging, obstetric anal sphincter injury

scholarly journals Effect of a subsequent pregnancy on anal sphincter integrity and function after obstetric anal sphincter injury (OASI)

2020 ◽  
Author(s):  
Nicola Adanna Okeahialam ◽  
Ranee Thakar ◽  
Abdul H. Sultan
Keyword(s):  
Anal Sphincter ◽  
Anal Manometry ◽  
Subsequent Pregnancy ◽  
Obstetric Anal Sphincter Injury ◽  
Sphincter Injury ◽  
Sphincter Defect ◽  
Squeeze Pressure ◽  
Anal Sphincter Injury ◽  
Significant Difference ◽  
Anal Sphincter Defect

Abstract Introduction and hypothesis Endoanal ultrasound (EAUS) and anal manometry are used in the assessment women with a history of obstetric anal sphincter injury (OASI), both postpartum and in a subsequent pregnancy, to aid counselling regarding mode of delivery (MOD). Methods A prospective observational study between 2012 to 2020 was completed. Women were reviewed 3 months postpartum following OASI and in the second half of a subsequent pregnancy. Anorectal symptoms were measured using the validated St Mark’s Incontinence Score (SMIS: asymptomatic to mild symptoms = ≤ 4). Anal manometry (incremental maximum squeeze pressure [iMSP: normal = > 20 mmHg]) and EAUS (abnormal = sphincter defect > 1 h in size) were performed. Results One hundred forty-six women were identified and 67.8% had an anal sphincter defect ≤ 1 h in size postnatally. In those with a defect ≤ 1 h, postpartum mean iMSP and SMIS significantly improved in a subsequent pregnancy (p = 0.04 and p = 0.01, respectively). In women with a defect > 1 h, there was no significant difference between the mean iMSP or SMIS score postnatally compared to a subsequent pregnancy. At both time points, significantly more women had an anal sphincter defect ≤ 1 h and SMIS of ≤ 4 (p = 0.001 and p < 0.001 respectively) compared to those with a defect < 1 h. In addition, significantly more women had an anal sphincter defect ≤ 1 h and iMSP ≥ 20 mmHg (p < 0.001). Overall, out of the 146 women included in this study, 76 (52.1%) with a defect ≤ 1 h also had an iMSP ≥ 20 mmHg and SMIS ≤ 4 at 3 months postpartum. Conclusions Women who remain asymptomatic with normal anal manometry and no abnormal sphincter defects on EAUS postnatally do not need to have these investigations repeated in a subsequent pregnancy and can be recommended to have a vaginal delivery. If our protocol was modified, over half of the women in this study could have had their MOD recommendation made in the postnatal period alone.

Impact of residual defect of anal sphincter on patient’s quality of life

2021 ◽  
Vol 86 (3) ◽  
pp. 163-166
Author(s):  
Petr Hubka ◽  
◽  
Rachid El Haddad ◽  
Jaromír Mašata ◽  
Alois Martan ◽  
...  
Keyword(s):  
Anal Sphincter ◽  
Sphincter Injury ◽  
Sphincter Defect ◽  
Anal Sphincter Injury ◽  
Sphincter Defects ◽  
Anal Sphincter Defect ◽  
Anal Sphincter Defects ◽  
Obstetrical Anal Sphincter Injury ◽  
Fecal Urgency

Summary Aim: The aim of this retrospective study is to correlate the presence of residual anal sphincter defect with the quality of life of patients after vaginal delivery complicated with obstetrical anal sphincter injury. Study group and methods: Patients diagnosed with obstetrical anal sphincter injury are dispensed at our urogynecological unit, with a mean follow-up period of 37 months. Two investigators blinded to the results of clinical symptoms evaluated archived ultrasound volumes taken for the presence of residual anal sphincter defects that were later correlated with the St. Mark’s Incontinence Score. Results: The group comprises of 181 patients diagnosed with an obstetrical anal sphincter injury who underwent ultrasound examination of anal sphincter at three post-partum months. The questionnaires were completed by 118 patients (65.2% of all patients). A residual sphincter defect was diagnosed in seven cases (5.9%). In the group with residual defects, fecal urgency (lack of ability to defer defecation) was present in 57.1%. In the group without residual anal sphincter defects, fecal urgency was present in 12.6%. This difference is significant (< 0.001) with the contingency coefficient 0.291. Conclusions: In conclusion, the presence of residual anal sphincter defect increases the probability of fecal urgency.

Internal anal sphincter defect influences continence outcome following obstetric anal sphincter injury

2007 ◽  
Vol 196 (3) ◽  
pp. 217.e1-217.e5 ◽  
Author(s):  
Rhona Mahony ◽  
Michael Behan ◽  
Leslie Daly ◽  
Catriona Kirwan ◽  
Colm O’Herlihy ◽  
...  
Keyword(s):  
Anal Sphincter ◽  
Internal Anal Sphincter ◽  
Obstetric Anal Sphincter Injury ◽  
Sphincter Injury ◽  
Sphincter Defect ◽  
Anal Sphincter Injury ◽  
Anal Sphincter Defect

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 Obstetric Anal Sphincter Injuries – Maternal, Foetal and Sociodemographic Risk Factors: A Retrospective Register-Based Study

2021 ◽  
Author(s):  
Kristin André ◽  
Andrea Stuart ◽  
Kärin Kallén
Keyword(s):  
Risk Factors ◽  
Birth Weight ◽  
Caesarean Section ◽  
Anal Sphincter ◽  
Maternal Education ◽  
Vacuum Extraction ◽  
High Birth Weight ◽  
Previous Caesarean Section ◽  
Obstetric Anal Sphincter Injuries ◽  
Increased Risk

Objective. To determine risk and protective factors of obstetric anal sphincter injuries (OASIS). Design. A retrospective register-based observational study. Setting. Sweden. Population. A cohort of 988, 988 singleton term deliveries 2005-2016 were included. Methods. Data from the Swedish Medical Birth Registry and Statistics Sweden were extracted to identify cases of OASIS and maternal and foetal characteristics. Modified Poisson Regression analyses were performed to assess risk factors. Main outcome measures. Risk ratios for OASIS with 95% confidence interval associated with maternal and foetal risk factors were calculated. Results. The rate of OASIS was 3.5% (n=34, 583). Primiparity (aRR 3.13 95% CI 3.05–3.21), vacuum extraction (aRR 2.79 95% CI 2.73–2.86), forceps (aRR 4.27 95% CI 3.86–4.72) and high birth weight (aRR 2.61 95% CI 2.50–2.72) were associated with a significantly increased risk of OASIS. Increasing maternal age and decreasing maternal height increased the risk of OASIS. Smoking (aRR 0.74 95% CI 0.70–0.79) and low maternal education (aRR 0.87 95% CI 0.83–0.92) were associated with a decreased frequency of reported OASIS. Obesity decreased the risk of OASIS (aRR 0.90 95% CI 0.87–0.94), but only after adjusting for foetal birth weight. Previous caesarean section increased the risk of OASIS (aRR 1.41; 95% CI 1.36–1.47). Conclusion. Primiparity, instrumental delivery and high birth weight increased the risk of OASIS. Risk factors including BMI, height, age, smoking, maternal education, ethnicity and previous caesarean section also contribute to the overall risk of OASIS. Keywords. Obstetric sphincter injuries, risk factors, pregnancy.

scholarly journals Abstract P33. Free Muscle Graft for Anal Sphincter Defect

2017 ◽  
Vol 5 ◽  
pp. 17
Author(s):  
Xiaoti Xu ◽  
William Y. Hoffman ◽  
Ankit Sarin ◽  
Jason H. Pomerantz
Keyword(s):  
Anal Sphincter ◽  
Sphincter Defect ◽  
Muscle Graft ◽  
Anal Sphincter Defect
Sign in / Sign up

Export Citation Format

Share Document