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Establishing a peripartum perineal trauma clinic: a narrative review

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Abstract

Introduction and hypothesis

Obstetric anal sphincter injury (OASI) is not rare, and its consequences are multiple and potentially severe, especially for young women. Some dedicated perineal clinics have been established to improve the management of OASI. Despite their obvious importance, these specific clinics are underrepresented and underdeveloped. The objectives of this review are to explore various options for developing a peripartum perineal clinic and to compare the different practices regarding the mode of delivery for subsequent pregnancies after an OASI.

Methods

This narrative review covers information from patients’ questionnaires specific to anal incontinence, anal physiology assessment, pelvic floor and anal sphincter imaging, and the arguments for choosing the mode of delivery after an OASI.

Results

This review highlights the extensive range of practices regarding the delivery mode after an OASI throughout national professional organizations and experienced perineal clinics.

Conclusion

This review summarizes the different choices in developing a perineal clinic to facilitate their development in promoting health care and education specific for peripartum women concerning the perineal consequences of delivery for obstetrician-gynaecologists, family doctors, and residents.

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References

  1. Harvey MA, Pierce M, Alter JE, Chou Q, Diamond P, Epp A, et al. Obstetrical anal sphincter injuries (OASIS): prevention, recognition, and repair. J Obstet Gynaecol Can. 2015;37(12):1131–48.

    Article  Google Scholar 

  2. Andrews V, Sultan AH, Thakar R, Jones PW. Occult anal sphincter injuries—myth or reality? BJOG. 2006;113(2):195–200. https://doi.org/10.1111/j.1471-0528.2006.00799.x.

    Article  PubMed  Google Scholar 

  3. Stock L, Basham E, Gossett DR, Lewicky-Gaupp C. Factors associated with wound complications in women with obstetric anal sphincter injuries (OASIS). Am J Obstet Gynecol. 2013;208(4):327 e321–6. https://doi.org/10.1016/j.ajog.2012.12.025.

    Article  Google Scholar 

  4. Das B, Snyder M. Rectovaginal fistulae. Clin Colon Rectal Surg. 2016;29(1):50–6. https://doi.org/10.1055/s-0035-1570393.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Oberwalder M, Connor J, Wexner SD. Meta-analysis to determine the incidence of obstetric anal sphincter damage. Br J Surg. 2003;90(11):1333–7. https://doi.org/10.1002/bjs.4369.

    Article  CAS  PubMed  Google Scholar 

  6. Thubert T, Cardaillac C, Fritel X, Winer N, Dochez V. Definition, epidemiology and risk factors of obstetric anal sphincter injuries: CNGOF perineal prevention and protection in obstetrics guidelines. Gynecol Obstet Fertil Senol. 2018;46(12):913–21. https://doi.org/10.1016/j.gofs.2018.10.028.

    Article  CAS  PubMed  Google Scholar 

  7. Shek KL, Guzman-Rojas R, Dietz HP. Residual defects of the external anal sphincter following primary repair: an observational study using transperineal ultrasound. Ultrasound Obstet Gynecol. 2014;44(6):704–9. https://doi.org/10.1002/uog.13368.

    Article  CAS  PubMed  Google Scholar 

  8. Turel FD, Langer S, Shek KL, Dietz HP. Medium- to long-term follow-up of obstetric anal sphincter injury. Dis Colon Rectum. 2019;62(3):348–56. https://doi.org/10.1097/DCR.0000000000001297.

    Article  PubMed  Google Scholar 

  9. Thomas GP, Gould LE, Casunuran F, Kumar DA. A retrospective review of 1495 patients with obstetric anal sphincter injuries referred for assessment of function and endoanal ultrasonography. Int J Color Dis. 2017;32(9):1321–5. https://doi.org/10.1007/s00384-017-2851-3.

    Article  CAS  Google Scholar 

  10. Fitzpatrick M, Cassidy M, O’Connell PR, O’Herlihy C. Experience with an obstetric perineal clinic. Eur J Obstet Gynecol Reprod Biol. 2002;100(2):199–203. https://doi.org/10.1016/s0301-2115(01)00427-4.

    Article  PubMed  Google Scholar 

  11. Fowler G, Williams A, Murphy G, Taylor K, Wood C, Adams E. How to set up a perineal clinic. Obstet Gynaecolt. 2009;11(2):129–32. https://doi.org/10.1576/toag.11.2.129.27487.

    Article  Google Scholar 

  12. Sultan AH, Thakar R. Lower genital tract and anal sphincter trauma. Best Pract Res Clin Obstet Gynaecol. 2002;16(1):99–115. https://doi.org/10.1053/beog.2002.0258.

    Article  PubMed  Google Scholar 

  13. RCOG. Royal College of Obstetricians and Gynaecologists: Green-top Guideline No. 29: The Management of Third- and Fourth-Degree Perineal Tears. 2015. London: Royal College of Obstetricians and Gynaecologists. https://www.rcog.org.uk/globalassets/documents/guidelines/gtg-29.pdf Accessed 1 May 2020.

  14. Ismail SI. The management of obstetric anal sphincter injuries (OASIS): a national postal questionnaire survey in hospitals in the U. K J Obstet Gynaecol. 2015;35(3):229–34. https://doi.org/10.3109/01443615.2014.954098.

    Article  CAS  PubMed  Google Scholar 

  15. Best C, Drutz HP, Alarab M. Obstetric anal sphincter injuries: a survey of clinical practice among Canadian obstetricians. J Obstet Gynaecol Can. 2012;34(8):747–54. https://doi.org/10.1016/S1701-2163(16)35338-5.

    Article  PubMed  Google Scholar 

  16. Futaba KRS, Webb S, Parsons M. Management of Perineal Trauma Complications: the role of the MDT. In: K I, editor. Perineal trauma at childbirth. Cham: Springer; 2016. https://doi.org/10.1007/978-3-319-14860-1_10.

    Chapter  Google Scholar 

  17. Scheer I, Thakar R, Sultan AH. Mode of delivery after previous obstetric anal sphincter injuries (OASIS)—a reappraisal? Int Urogynecol J Pelvic Floor Dysfunct. 2009;20(9):1095–101. https://doi.org/10.1007/s00192-009-0908-8.

    Article  PubMed  Google Scholar 

  18. Karmarkar R, Bhide A, Digesu A, Khullar V, Fernando R. Mode of delivery after obstetric anal sphincter injury. Eur J Obstet Gynecol Reprod Biol. 2015;194:7–10. https://doi.org/10.1016/j.ejogrb.2015.07.019.

    Article  PubMed  Google Scholar 

  19. Cassis C, Giarenis I, Mukhopadhyay S, Morris E. Mode of delivery following an OASIS and caesarean section rates. Eur J Obstet Gynecol Reprod Biol. 2018;230:28–31. https://doi.org/10.1016/j.ejogrb.2018.09.020.

    Article  PubMed  Google Scholar 

  20. Pretlove S, Thompson PJ, Toozs-Hobson PM, Radley S. The first 18 months of a new perineal trauma clinic. J Obstet Gynaecol. 2004;24(4):399–402. https://doi.org/10.1080/01443610410001685538.

    Article  PubMed  Google Scholar 

  21. Lewicky-Gaupp C, Leader-Cramer A, Johnson LL, Kenton K, Gossett DR. Wound complications after obstetric anal sphincter injuries. Obstet Gynecol. 2015;125(5):1088–93. https://doi.org/10.1097/AOG.0000000000000833.

    Article  PubMed  Google Scholar 

  22. Anglim B, Kelly L, Fitzpatrick M. Risk factors and outcome of repair of obstetric anal sphincter injuries as followed up in a dedicated perineal clinic. Int Urogynecol J. 2019;30(10):1649–55. https://doi.org/10.1007/s00192-019-03960-7.

    Article  PubMed  Google Scholar 

  23. Brincat C, Crosby E, McLeod A, Fenner DE. Experiences during the first four years of a postpartum perineal clinic in the USA. Int J Gynaecol Obstet. 2015;128(1):68–71. https://doi.org/10.1016/j.ijgo.2014.07.026.

    Article  PubMed  Google Scholar 

  24. Jordan PA, Naidu M, Thakar R, Sultan AH. Effect of subsequent vaginal delivery on bowel symptoms and anorectal function in women who sustained a previous obstetric anal sphincter injury. Int Urogynecol J. 2018;29(11):1579–88. https://doi.org/10.1007/s00192-018-3601-y.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Fitzpatrick M, Cassidy M, Barassaud ML, Hehir MP, Hanly AM, O’Connell PR, et al. Does anal sphincter injury preclude subsequent vaginal delivery? Eur J Obstet Gynecol Reprod Biol. 2016;198:30–4. https://doi.org/10.1016/j.ejogrb.2015.12.004.

    Article  CAS  PubMed  Google Scholar 

  26. Jorge JM, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum. 1993;36(1):77–97. https://doi.org/10.1007/BF02050307.

    Article  CAS  PubMed  Google Scholar 

  27. Vaizey CJ, Carapeti E, Cahill JA, Kamm MA. Prospective comparison of faecal incontinence grading systems. Gut. 1999;44(1):77–80. https://doi.org/10.1136/gut.44.1.77.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Sultan AH, Monga A, Lee J, Emmanuel A, Norton C, Santoro G, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female anorectal dysfunction. Int Urogynecol J. 2017;28(1):5–31. https://doi.org/10.1007/s00192-016-3140-3.

    Article  PubMed  Google Scholar 

  29. Pescatori M, Anastasio G, Bottini C, Mentasti A. New grading and scoring for anal incontinence. Evaluation of 335 patients. Dis Colon Rectum. 1992;35(5):482–7. https://doi.org/10.1007/BF02049407.

    Article  CAS  PubMed  Google Scholar 

  30. Rockwood TH, Church JM, Fleshman JW, Kane RL, Mavrantonis C, Thorson AG, et al. Patient and surgeon ranking of the severity of symptoms associated with fecal incontinence: the fecal incontinence severity index. Dis Colon Rectum. 1999;42(12):1525–32. https://doi.org/10.1007/BF02236199.

    Article  CAS  PubMed  Google Scholar 

  31. Roos AM, Sultan AH, Thakar R. St. Mark’s incontinence score for assessment of anal incontinence following obstetric anal sphincter injuries (OASIS). Int Urogynecol J Pelvic Floor Dysfunct. 2009;20(4):407–10. https://doi.org/10.1007/s00192-008-0784-7.

    Article  PubMed  Google Scholar 

  32. van der Vlist M, Oom D, van Rosmalen J, van Ovost A, Hogewoning C. Parturition mode recommendation and symptoms of pelvic floor disorders after obstetric anal sphincter injuries. Int Urogynecol J. 2020. https://doi.org/10.1007/s00192-020-04241-4.

  33. Johannessen HH, Norderval S, Stordahl A, Falk RS, Wibe A. Interview-based versus self-reported anal incontinence using St Mark’s incontinence score. Int Urogynecol J. 2018;29(5):667–71. https://doi.org/10.1007/s00192-017-3363-y.

    Article  PubMed  Google Scholar 

  34. Maeda Y, Pares D, Norton C, Vaizey CJ, Kamm MA. Does the St. Mark’s incontinence score reflect patients’ perceptions? A review of 390 patients. Dis Colon Rectum. 2008;51(4):436–42. https://doi.org/10.1007/s10350-007-9157-4.

    Article  PubMed  Google Scholar 

  35. Guzman Rojas RA, Kamisan Atan I, Shek KL, Dietz HP. Anal sphincter trauma and anal incontinence in urogynecological patients. Ultrasound Obstet Gynecol. 2015;46(3):363–6. https://doi.org/10.1002/uog.14845.

    Article  CAS  PubMed  Google Scholar 

  36. Valsky DV, Cohen SM, Lipschuetz M, Hochner-Celnikier D, Yagel S. Three-dimensional transperineal ultrasound findings associated with anal incontinence after intrapartum sphincter tears in primiparous women. Ultrasound Obstet Gynecol. 2012;39(1):83–90. https://doi.org/10.1002/uog.10072.

    Article  CAS  PubMed  Google Scholar 

  37. Bonniaud V, Guyatt G, Bonniaud P, Perennou D, Parratte B. Choosing a quality-of-life questionnaire. Presse Med. 2006;35(2 Pt 2):281–6. https://doi.org/10.1016/s0755-4982(06)74571-7.

    Article  PubMed  Google Scholar 

  38. Lee JT, Madoff RD, Rockwood TH. Quality-of-life measures in fecal incontinence: is validation valid? Dis Colon Rectum. 2015;58(3):352–7. https://doi.org/10.1097/DCR.0000000000000290.

    Article  PubMed  Google Scholar 

  39. Paquette IM, Varma MG, Kaiser AM, Steele SR, Rafferty JF. The American Society of Colon and Rectal Surgeons’ clinical practice guideline for the treatment of fecal incontinence. Dis Colon Rectum. 2015;58(7):623–36. https://doi.org/10.1097/DCR.0000000000000397.

    Article  PubMed  Google Scholar 

  40. Rockwood TH, Church JM, Fleshman JW, Kane RL, Mavrantonis C, Thorson AG, et al. Fecal incontinence quality of life scale: quality of life instrument for patients with fecal incontinence. Dis Colon Rectum. 2000;43(1):9–16; discussion 16-17. https://doi.org/10.1007/bf02237236.

    Article  CAS  PubMed  Google Scholar 

  41. Rullier E, Zerbib F, Marrel A, Amouretti M, Lehur PA. Validation of the French version of the fecal incontinence quality-of-life (FIQL) scale. Gastroenterol Clin Biol. 2004;28(6-7 Pt 1):562–8. https://doi.org/10.1016/s0399-8320(04)95012-9.

    Article  PubMed  Google Scholar 

  42. Bordeianou L, Rockwood T, Baxter N, Lowry A, Mellgren A, Parker S. Does incontinence severity correlate with quality of life? Prospective analysis of 502 consecutive patients. Color Dis. 2008;10(3):273–9. https://doi.org/10.1111/j.1463-1318.2007.01288.x.

    Article  CAS  Google Scholar 

  43. Abdool Z, Sultan AH, Thakar R. Ultrasound imaging of the anal sphincter complex: a review. Br J Radiol. 2012;85(1015):865–75. https://doi.org/10.1259/bjr/27314678.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Sultan AH, Kamm MA, Talbot IC, Nicholls RJ, Bartram CI. Anal endosonography for identifying external sphincter defects confirmed histologically. Br J Surg. 1994;81(3):463–5. https://doi.org/10.1002/bjs.1800810349.

    Article  CAS  PubMed  Google Scholar 

  45. Gurland B, Hull T. Transrectal ultrasound, manometry, and pudendal nerve terminal latency studies in the evaluation of sphincter injuries. Clin Colon Rectal Surg. 2008;21(3):157–66. https://doi.org/10.1055/s-2008-1080995.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Roos AM, Thakar R, Sultan AH. Outcome of primary repair of obstetric anal sphincter injuries (OASIS): does the grade of tear matter? Ultrasound Obstet Gynecol. 2010;36(3):368–74. https://doi.org/10.1002/uog.7512.

    Article  PubMed  Google Scholar 

  47. Webb SS, Sitch A, MacArthur C. The impact of mode of subsequent birth after obstetric anal sphincter injury on bowel function and related quality of life: a cohort study. Int Urogynecol J. 2020. https://doi.org/10.1007/s00192-020-04234-3.

  48. Belmonte-Montes C, Hagerman G, Vega-Yepez PA, Hernandez-de-Anda E, Fonseca-Morales V. Anal sphincter injury after vaginal delivery in primiparous females. Dis Colon Rectum. 2001;44(9):1244–8. https://doi.org/10.1007/BF02234778.

    Article  CAS  PubMed  Google Scholar 

  49. Norderval S, Rossaak K, Markskog A, Vonen B. Incontinence after primary repair of obstetric anal sphincter tears is related to relative length of reconstructed external sphincter: a case-control study. Ultrasound Obstet Gynecol. 2012;40(2):207–14. https://doi.org/10.1002/uog.10154.

    Article  CAS  PubMed  Google Scholar 

  50. Norderval S, Markskog A, Rossaak K, Vonen B. Correlation between anal sphincter defects and anal incontinence following obstetric sphincter tears: assessment using scoring systems for sonographic classification of defects. Ultrasound Obstet Gynecol. 2008;31(1):78–84. https://doi.org/10.1002/uog.5155.

    Article  CAS  PubMed  Google Scholar 

  51. Starck M, Bohe M, Valentin L. The extent of endosonographic anal sphincter defects after primary repair of obstetric sphincter tears increases over time and is related to anal incontinence. Ultrasound Obstet Gynecol. 2006;27(2):188–97. https://doi.org/10.1002/uog.2630.

    Article  CAS  PubMed  Google Scholar 

  52. Fynes M, Donnelly V, Behan M, O’Connell PR, O’Herlihy C. Effect of second vaginal delivery on anorectal physiology and faecal continence: a prospective study. Lancet. 1999;354(9183):983–6. https://doi.org/10.1016/S0140-6736(98)11205-9.

    Article  CAS  PubMed  Google Scholar 

  53. Sideris M, McCaughey T, Hanrahan JG, Arroyo-Manzano D, Zamora J, Jha S, et al. Risk of obstetric anal sphincter injuries (OASIS) and anal incontinence: a meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2020;252:303–12. https://doi.org/10.1016/j.ejogrb.2020.06.048.

    Article  PubMed  Google Scholar 

  54. Yagel S, Valsky DV. Three-dimensional transperineal ultrasonography for evaluation of the anal sphincter complex: another dimension in understanding peripartum sphincter trauma. Ultrasound Obstet Gynecol. 2006;27(2):119–23. https://doi.org/10.1002/uog.2714.

    Article  CAS  PubMed  Google Scholar 

  55. Valsky DV, Messing B, Petkova R, Savchev S, Rosenak D, Hochner-Celnikier D, et al. Postpartum evaluation of the anal sphincter by transperineal three-dimensional ultrasound in primiparous women after vaginal delivery and following surgical repair of third-degree tears by the overlapping technique. Ultrasound Obstet Gynecol. 2007;29(2):195–204. https://doi.org/10.1002/uog.3923.

    Article  CAS  PubMed  Google Scholar 

  56. Oom DM, West RL, Schouten WR, Steensma AB. Detection of anal sphincter defects in female patients with fecal incontinence: a comparison of 3-dimensional transperineal ultrasound and 2-dimensional endoanal ultrasound. Dis Colon Rectum. 2012;55(6):646–52. https://doi.org/10.1097/DCR.0b013e318251dca1.

    Article  PubMed  Google Scholar 

  57. Stuart A, Ignell C, Orno AK. Comparison of transperineal and endoanal ultrasound in detecting residual obstetric anal sphincter injury. Acta Obstet Gynecol Scand. 2019;98(12):1624–31. https://doi.org/10.1111/aogs.13701.

    Article  PubMed  Google Scholar 

  58. Ros C, Martinez-Franco E, Wozniak MM, Cassado J, Santoro GA, Elias N, et al. Postpartum two- and three-dimensional ultrasound evaluation of anal sphincter complex in women with obstetric anal sphincter injury. Ultrasound Obstet Gynecol. 2017;49(4):508–14. https://doi.org/10.1002/uog.15924.

    Article  CAS  PubMed  Google Scholar 

  59. Taithongchai A, van Gruting IMA, Volloyhaug I, Arendsen LP, Sultan AH, Thakar R. Comparing the diagnostic accuracy of 3 ultrasound modalities for diagnosing obstetric anal sphincter injuries. Am J Obstet Gynecol. 2019;221(2):134 e131–9. https://doi.org/10.1016/j.ajog.2019.04.009.

    Article  Google Scholar 

  60. Turel Fatakia F, Subramaniam N, Bienkiewicz J, Friedman T, Dietz HP. How repeatable is assessment of external anal sphincter trauma by exoanal 4D ultrasound? Ultrasound Obstet Gynecol. 2019;53(6):836–40. https://doi.org/10.1002/uog.20175.

    Article  CAS  PubMed  Google Scholar 

  61. Volloyhaug I, Taithongchai A, Arendsen L, van Gruting I, Sultan AH, Thakar R. Is endoanal, introital or transperineal ultrasound diagnosis of sphincter defects more strongly associated with anal incontinence? Int Urogynecol J. 2020;31(7):1471–8. https://doi.org/10.1007/s00192-020-04274-9.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Cattani L, Van Schoubroeck D, Housmans S, Callewaert G, Werbrouck E, Verbakel JY, et al. Exo-anal imaging of the anal sphincter: a comparison between introital and transperineal image acquisition. Int Urogynecol J. 2020;31(6):1107–13. https://doi.org/10.1007/s00192-019-04122-5.

    Article  PubMed  Google Scholar 

  63. Bo K, Finckenhagen HB. Vaginal palpation of pelvic floor muscle strength: inter-test reproducibility and comparison between palpation and vaginal squeeze pressure. Acta Obstet Gynecol Scand. 2001;80(10):883–7. https://doi.org/10.1034/j.1600-0412.2001.801003.x.

    Article  CAS  PubMed  Google Scholar 

  64. Navarro Brazalez B, Torres Lacomba M, de la Villa P, Sanchez Sanchez B, Prieto Gomez V, Asunsolo Del Barco A, et al. The evaluation of pelvic floor muscle strength in women with pelvic floor dysfunction: a reliability and correlation study. Neurourol Urodyn. 2018;37(1):269–77. https://doi.org/10.1002/nau.23287.

    Article  PubMed  Google Scholar 

  65. Ferreira CH, Barbosa PB, de Oliveira Souza F, Antonio FI, Franco MM, Bo K. Inter-rater reliability study of the modified Oxford grading scale and the Peritron manometer. Physiotherapy. 2011;97(2):132–8. https://doi.org/10.1016/j.physio.2010.06.007.

    Article  PubMed  Google Scholar 

  66. van Delft K, Thakar R, Sultan AH. Pelvic floor muscle contractility: digital assessment vs transperineal ultrasound. Ultrasound Obstet Gynecol. 2015;45(2):217–22. https://doi.org/10.1002/uog.13456.

    Article  PubMed  Google Scholar 

  67. Albrich S, Steetskamp J, Knoechel SL, Porta S, Hoffmann G, Skala C. Assessment of pelvic floor muscle contractility: digital palpation versus 2D and 3D perineal ultrasound. Arch Gynecol Obstet. 2016;293(4):839–43. https://doi.org/10.1007/s00404-015-3897-5.

    Article  PubMed  Google Scholar 

  68. Volloyhaug I, Morkved S, Salvesen O, Salvesen KA. Assessment of pelvic floor muscle contraction with palpation, perineometry and transperineal ultrasound: a cross-sectional study. Ultrasound Obstet Gynecol. 2016;47(6):768–73. https://doi.org/10.1002/uog.15731.

    Article  CAS  PubMed  Google Scholar 

  69. Nyhus MO, Oversand SH, Salvesen O, Salvesen KA, Mathew S, Volloyhaug I. Ultrasound assessment of pelvic floor muscle contraction: reliability and development of an ultrasound-based contraction scale. Ultrasound Obstet Gynecol. 2020;55(1):125–31. https://doi.org/10.1002/uog.20382.

    Article  CAS  PubMed  Google Scholar 

  70. Dietz HP, Bernardo MJ, Kirby A, Shek KL. Minimal criteria for the diagnosis of avulsion of the puborectalis muscle by tomographic ultrasound. Int Urogynecol J. 2011;22(6):699–704. https://doi.org/10.1007/s00192-010-1329-4.

    Article  PubMed  Google Scholar 

  71. Chantarasorn V, Shek KL, Dietz HP. Sonographic detection of puborectalis muscle avulsion is not associated with anal incontinence. Aust N Z J Obstet Gynaecol. 2011;51(2):130–5. https://doi.org/10.1111/j.1479-828X.2010.01273.x.

    Article  PubMed  Google Scholar 

  72. Murad-Regadas SM, da SFGO, Regadas FS, Rodrigues LV, Filho FS, Dealcanfreitas ID, et al. Usefulness of anorectal and endovaginal 3D ultrasound in the evaluation of sphincter and pubovisceral muscle defects using a new scoring system in women with fecal incontinence after vaginal delivery. Int J Color Dis. 2017;32(4):499–507. https://doi.org/10.1007/s00384-016-2750-z.

    Article  Google Scholar 

  73. Heilbrun ME, Nygaard IE, Lockhart ME, Richter HE, Brown MB, Kenton KS, et al. Correlation between levator ani muscle injuries on magnetic resonance imaging and fecal incontinence, pelvic organ prolapse, and urinary incontinence in primiparous women. Am J Obstet Gynecol. 2010;202(5):488 e481–6. https://doi.org/10.1016/j.ajog.2010.01.002.

    Article  Google Scholar 

  74. Martinez Franco E, Lopez Negre JL, Pares D, Ros Cerro C, Amat Tardiu L, Cuadras D, et al. Anatomic and functional evaluation of the levator ani muscle after an obstetric anal sphincter injury. Arch Gynecol Obstet. 2019;299(4):1001–6. https://doi.org/10.1007/s00404-019-05070-7.

    Article  PubMed  Google Scholar 

  75. Lewicky-Gaupp C, Brincat C, Yousuf A, Patel DA, Delancey JO, Fenner DE. Fecal incontinence in older women: are levator ani defects a factor? Am J Obstet Gynecol. 2010;202(5):491 e491–6. https://doi.org/10.1016/j.ajog.2010.01.020.

    Article  Google Scholar 

  76. Carrington EV, Heinrich H, Knowles CH, Fox M, Rao S, Altomare DF, et al. The international anorectal physiology working group (IAPWG) recommendations: standardized testing protocol and the London classification for disorders of anorectal function. Neurogastroenterol Motil. 2020;32(1):e13679. https://doi.org/10.1111/nmo.13679.

    Article  PubMed  Google Scholar 

  77. Brusciano LDSC, Lucido F, Del Genio A. Manometry, rectoanal inhibition and compliance assessment in proctologic practice: approaches in the reoperative case. In: Reconstructive surgery of the rectum, anus and perineum. London: Springer; 2013. https://doi.org/10.1007/978-1-84882-413-3_6.

    Chapter  Google Scholar 

  78. Papaconstantinou HT. Evaluation of anal incontinence: minimal approach, maximal effectiveness. Clin Colon Rectal Surg. 2005;18(1):9–16. https://doi.org/10.1055/s-2005-864076.

    Article  PubMed  PubMed Central  Google Scholar 

  79. Chaliha C, Sultan AH, Emmanuel AV. Normal ranges for anorectal manometry and sensation in women of reproductive age. Color Dis. 2007;9(9):839–44. https://doi.org/10.1111/j.1463-1318.2007.01212.x.

    Article  CAS  Google Scholar 

  80. Nazir M, Carlsen E, Jacobsen AF, Nesheim BI. Is there any correlation between objective anal testing, rupture grade, and bowel symptoms after primary repair of obstetric anal sphincter rupture?: an observational cohort study. Dis Colon Rectum. 2002;45(10):1325–31. https://doi.org/10.1007/s10350-004-6419-2.

    Article  PubMed  Google Scholar 

  81. de Leeuw JW, Vierhout ME, Struijk PC, Auwerda HJ, Bac DJ, Wallenburg HC. Anal sphincter damage after vaginal delivery: relationship of anal endosonography and manometry to anorectal complaints. Dis Colon Rectum. 2002;45(8):1004–10. https://doi.org/10.1007/s10350-004-6351-5.

    Article  PubMed  Google Scholar 

  82. Parangama C, Anu E, Sukria N. Endoanal ultrasound assessment of sphincter defects and thinning--correlation with anal manometry. Arab J Gastroenterol. 2014;15(1):27–31. https://doi.org/10.1016/j.ajg.2014.01.006.

    Article  PubMed  Google Scholar 

  83. Ha HT, Fleshman JW, Smith M, Read TE, Kodner IJ, Birnbaum EH. Manometric squeeze pressure difference parallels functional outcome after overlapping sphincter reconstruction. Dis Colon Rectum. 2001;44(5):655–60. https://doi.org/10.1007/BF02234561.

    Article  CAS  PubMed  Google Scholar 

  84. Elton C, Stoodley BJ. Anterior anal sphincter repair: results in a district general hospital. Ann R Coll Surg Engl. 2002;84(5):321–4. https://doi.org/10.1308/003588402760452420.

    Article  PubMed  PubMed Central  Google Scholar 

  85. Zutshi M, Salcedo L, Hammel J, Hull T. Anal physiology testing in fecal incontinence: is it of any value? Int J Color Dis. 2010;25(2):277–82. https://doi.org/10.1007/s00384-009-0830-z.

    Article  Google Scholar 

  86. Roos AM, Abdool Z, Thakar R, Sultan AH. Predicting anal sphincter defects: the value of clinical examination and manometry. Int Urogynecol J. 2012;23(6):755–63. https://doi.org/10.1007/s00192-011-1609-7.

    Article  PubMed  Google Scholar 

  87. Jha S, Parker V. Risk factors for recurrent obstetric anal sphincter injury (rOASI): a systematic review and meta-analysis. Int Urogynecol J. 2016;27(6):849–57. https://doi.org/10.1007/s00192-015-2893-4.

    Article  PubMed  Google Scholar 

  88. D’Souza JC, Monga A, Tincello DG, Sultan AH, Thakar R, Hillard TC, et al. Maternal outcomes in subsequent delivery after previous obstetric anal sphincter injury (OASI): a multi-centre retrospective cohort study. Int Urogynecol J. 2020;31(3):627–33. https://doi.org/10.1007/s00192-019-03983-0.

    Article  PubMed  Google Scholar 

  89. Aigmueller T, Bader W, Beilecke K, Elenskaia K, Frudinger A, Hanzal E, et al. Management of 3rd and 4th degree perineal tears after vaginal birth. German guideline of the German Society of Gynecology and Obstetrics (AWMF registry no. 015/079, October 2014). Geburtshilfe Frauenheilkd. 2015;75(2):137–44. https://doi.org/10.1055/s-0034-1396323.

  90. Queensland Clinical Guidelines (2018) Maternity and neonatal clnical gudeline -perneal care. https://wwwhealthqldgovau/__data/assets/pdf_file/0022/142384/g-pericarepdf. Accessed 23 April 2020.

  91. Gachon B. Cesarean section and perineal protection: CNGOF perineal prevention and protection in obstetrics Guidelines. Gynecol Obstet Fertil Senol. 2018;46(12):968–85. https://doi.org/10.1016/j.gofs.2018.10.030.

    Article  CAS  PubMed  Google Scholar 

  92. Taithongchai A, Thakar R, Sultan AH. Management of subsequent pregnancies following fourth-degree obstetric anal sphincter injuries (OASIS). Eur J Obstet Gynecol Reprod Biol. 2020;250:80–5. https://doi.org/10.1016/j.ejogrb.2020.04.063.

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors thank Mengting Xu for proofreading this manuscript.

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Authors and Affiliations

  1. Department of Obstetrics and Gynaecology, Université de Montréal and Centre Hospitalier de l’Université de Montréal (CHUM), Montréal, Canada

    Aurore Fehlmann, Barbara Reichetzer, Stéphane Ouellet, Catherine Tremblay & Marie-Eve Clermont

  2. Department of Paediatrics, Gynaecology and Obstetrics, Geneva University Hospitals and Faculty of Medecine, Geneva, Switzerland

    Aurore Fehlmann

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  1. Aurore Fehlmann
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  2. Barbara Reichetzer
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Fehlmann, A., Reichetzer, B., Ouellet, S. et al. Establishing a peripartum perineal trauma clinic: a narrative review. Int Urogynecol J 32, 1653–1662 (2021). https://doi.org/10.1007/s00192-020-04631-8

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