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Endoanal ultrasound for detection of sphincter defects following childbirth

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Abstract

Introduction and hypothesis

The objectives of this study were to estimate the rates of sonographically detected anal sphincter defects within 72 h of childbirth and to evaluate intra- and interobserver agreement using three-dimensional (3-D) endoanal sonography data.

Methods

This is a prospective observational study of primiparous women delivered vaginally. Women without clinically identified anal sphincter lacerations underwent endoanal ultrasonography within 72 h of delivery. Intra- and interobserver agreement for diagnosis of sphincter defects using 3-D endoanal sonography data was calculated using kappa statistics.

Results

The rate of sphincter defects in 107 women undergoing 3-D endoanal sonography was 12 %. Characteristics of women with sonographically detected sphincter defects, compared to those without, included a significantly increased rate of clinically diagnosed second-degree lacerations (54 vs 20 %, p 0.008). The intra- and interobserver agreement for diagnosis of sphincter defects using 3-D endoanal sonography data was 0.82 [confidence interval (CI) 0.66–0.99] and 0.72 (CI 0.54–0.92), respectively.

Conclusions

Anal sphincter defects detected using endoanal sonography are common, occurring in 12 % of primiparous women, and are significantly associated with other less severe perineal lacerations. Overall and combining sonographically detected defects with clinically diagnosed lacerations, we estimate that 17.8 % of primiparous women delivered vaginally sustain anal sphincter injuries. The intraobserver agreement for diagnosis of sphincter defects is very good and the interobserver agreement is good.

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References

  1. Sultan AH, Kamm MA, Hudson CN, Thomas JM, Bartram CI (1993) Anal-sphincter disruption during vaginal delivery. N Engl J Med 329:1905–1911

    Article  PubMed  CAS  Google Scholar 

  2. Crawford LA, Quint EH, Pearl ML, DeLancey JOL (1993) Incontinence following rupture of the anal sphincter during delivery. Obstet Gynecol 82:527–531

    PubMed  CAS  Google Scholar 

  3. Sultan AH, Kamm MA, Hudson CN, Bartram CI (1994) Third degree obstetric anal sphincter tears: risk factors and outcomes of primary repair. BMJ 308:887–889

    Article  PubMed  CAS  Google Scholar 

  4. Borello-France D, Burgio KL, Richter HE et al (2006) Fecal and urinary incontinence in primiparous women. Obstet Gynecol 108:863–872

    Article  PubMed  Google Scholar 

  5. Richter HE, Fielding JR, Bradley CS et al (2006) Endoanal ultrasound findings and fecal incontinence symptoms in women with and without recognized anal sphincter tears. Obstet Gynecol 108:1394–1401

    Article  PubMed  Google Scholar 

  6. Hamilton BE, Martin JA, Ventura SJ (2010) Births: preliminary data for 2009 (online). National vital statistics report; vol 59 no 3. National Center for Health Statistics

  7. Handa VL, Danielsen BH, Gilbert WM (2001) Obstetric anal sphincter lacerations. Obstet Gynecol 98(2):225–230

    Article  PubMed  CAS  Google Scholar 

  8. Fenner DE, Genberg B, Brahma P, Marek L, DeLancey JO (2003) Fecal and urinary incontinence after vaginal delivery with anal sphincter disruption in an obstetrics unit in the United States. Am J Obstet Gynecol 189:1543–1550

    Article  PubMed  Google Scholar 

  9. Haadem K, Ohrlander S, Lingman G (1988) Long-term ailments due to anal sphincter rupture caused by delivery—a hidden problem. Eur J Obstet Gynecol Reprod Biol 27:27–32

    Article  PubMed  CAS  Google Scholar 

  10. Haadem K, Dahlström JA, Lingman G (1990) Anal sphincter function after delivery: a prospective study in women with sphincter rupture and controls. Eur J Obstet Gynecol Reprod Biol 35:7–13

    Article  PubMed  CAS  Google Scholar 

  11. Fitzpatrick M, Behan M, O’Connell PR, O’Herlihy C (2000) A randomized clinical trial comparing primary overlap with approximation repair of third-degree obstetric tears. Am J Obstet Gynecol 183:1220–1224

    Article  PubMed  CAS  Google Scholar 

  12. Zetterström J, López A, Holmström B, Nilsson BY, Tisell A, Anzén B et al (2003) Obstetric sphincter tears and anal incontinence: an observational follow-up study. Acta Obstet Gynecol Scand 82:921–928

    PubMed  Google Scholar 

  13. Oberwalder M, Connor J, Wexner SD (2003) Meta-analysis to determine the incidence of obstetric anal sphincter damage. Br J Surg 90(11):1333–1337

    Article  PubMed  CAS  Google Scholar 

  14. Andrews V, Sultan AH, Thakar R, Jones PW (2006) Occult anal sphincter injuries—myth or reality? BJOG 113:195–200

    Article  PubMed  Google Scholar 

  15. Andrews V, Thakar R, Sultan AH (2009) Structured hands-on training in repair of obstetric anal sphincter injuries (OASIS): an audit of clinical practice. Int Urogynecol J Pelvic Floor Dysfunct 20:193–199

    Article  PubMed  Google Scholar 

  16. Chao TT, Wendel GD Jr, McIntire DD, Corton MM (2010) Effectiveness of an instructional DVD on third- and fourth-degree laceration repair for obstetrics and gynecology postgraduate trainees. Int J Gynaecol Obstet 109(1):16–19

    Article  PubMed  Google Scholar 

  17. Uppal S, Harmanli O, Rowland J, Hernandez E, Dandolu V (2010) Resident competency in obstetric anal sphincter laceration repair. Obstet Gynecol 115(2):305–309

    Article  PubMed  Google Scholar 

  18. Patel M, LaSala C, Tulikangas P, O’Sullivan DM, Steinberg AC (2010) Use of a beef tongue model and instructional video for teaching residents fourth-degree laceration repair. Int Urogynecol J 21:353–358

    Article  PubMed  Google Scholar 

  19. Roshanravan SR, Pietz JT, Chao TT, Corton MM (2008) Fourth degree obstetrical lacerations: anatomy and repair. The American College of Obstetricians and Gynecologists. Available via: http://www.acog.org/bookstore/Fourth_Degree_Obstetrical_Lace_P608C85.cfm. Accessed November 2009

  20. Fynes M, Donnelly V, Behan M, O’Connell PR, O’Herlihy C (1999) Effect of second vaginal delivery on anorectal physiology and faecal continence: a prospective study. Lancet 354:983–986

    Article  PubMed  CAS  Google Scholar 

  21. Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Routh DJ, Spong CY. Williams obstetrics, 23rd edn. Normal labor and delivery. McGraw-Hill, New York, pp 324–409

  22. Bollard RC, Gardiner A, Lindow S, Phillips K, Duthie GS (2002) Normal female anal sphincter: difficulties in interpretation explained. Dis Colon Rectum 45:171–175

    Article  PubMed  CAS  Google Scholar 

  23. Cohen J (1968) Weighted kappa: nominal scale agreement with provision for scaled disagreement or partial credit. Psychol Bull 70:213–220

    Article  PubMed  CAS  Google Scholar 

  24. Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174

    Article  PubMed  CAS  Google Scholar 

  25. Gold DM, Halligan S, Kmiot WA, Bartram CI (1999) Intraobserver and interobserver agreement in anal endosonography. Br J Surg 86:371–375

    Article  PubMed  CAS  Google Scholar 

  26. Groom KM, Paterson-Brown S (2002) Can we improve on the diagnosis of third degree tears? Eur J Obstet Gynecol Reprod Biol 101(1):19–21

    Article  PubMed  Google Scholar 

  27. Webb DA, Culhane J (2002) Hospital variation in episiotomy use and the risk of perineal trauma during childbirth. Birth 29(2):132–136

    Article  PubMed  Google Scholar 

  28. Gold DM, Bartram CI, Halligan S, Humphries KN, Kamm MA, Kmiot WA (1999) Three-dimensional endoanal sonography in assessing anal canal injury. Br J Surg 86:365–370

    Article  PubMed  CAS  Google Scholar 

  29. Norderval S, Dehli T, Vonen B (2009) Three-dimensional endoanal ultrasonography: intraobserver and interobserver agreement using scoring systems for classification of anal sphincter defects. Ultrasound Obstet Gynecol 33:337–343

    Article  PubMed  CAS  Google Scholar 

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Acknowledgment

The study was supported by NIH CTSA Grant UL1 RR024982.

Conflicts of interest

None.

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Authors and Affiliations

  1. Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9032, USA

    Marlene M. Corton, Shanna Atnip & Joseph I. Schaffer

  2. Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Donald D. McIntire & Kenneth J. Leveno

  3. Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Diane M. Twickler

Authors
  1. Marlene M. Corton
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  2. Donald D. McIntire
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  3. Diane M. Twickler
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  4. Shanna Atnip
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  5. Joseph I. Schaffer
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  6. Kenneth J. Leveno
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Corresponding author

Correspondence to Marlene M. Corton.

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Corton, M.M., McIntire, D.D., Twickler, D.M. et al. Endoanal ultrasound for detection of sphincter defects following childbirth. Int Urogynecol J 24, 627–635 (2013). https://doi.org/10.1007/s00192-012-1893-x

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  • DOI: https://doi.org/10.1007/s00192-012-1893-x

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