Abstract
Introduction and hypothesis
In this study we described a new technical approach to adapt endovaginal ultrasound scanning of the anal sphincter complex to the immediate postpartum period.
Methods
We analyzed the clinical and ultrasonographic examinations of 18 primiparous women presenting deep perineal tears with potential or clearly identified lesions of the anal sphincter. Potential anal sphincter lesion was defined as a second degree perineal tear extending close to the anal sphincter with exposition of its capsule or muscular fibers. We reported interesting ultrasonographic images explaining our technique in a video.
Results
We reported clinical and ultrasonographic features in nine cases of grade 2, four cases of grade 3a, four cases of grade 3b and one case of grade 3c perineal tears. The ultrasonographic examination confirmed the intact state of the anal sphincter complex in all patients with clinical grade 2 tears except one in which a grade 3b lesion was detected. We were not able to identify external anal sphincter lesions on ultrasound in any of the patients with clinical grade 3a tears. In patients with clinical grade 3b tears, the ultrasound confirmed the external anal sphincter lesion in all cases, but revealed additional involvement of the internal anal sphincter in 1 case (grade 3c).
Conclusion
Immediate postpartum endovaginal ultrasound could be a promising technique to improve the management of perineal traumas after vaginal delivery.
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Consent
Written informed consent was obtained from the patient for publication of this video article and any accompanying images.
References
Faltin DL, Boulvain M, Floria LA, Irion O. Diagnosis of anal sphincter tears to prevent fecal incontinence. Obstet Gynecol. 2005;106(1):6–13.
Harvey MA, Pierce M. Obstetrical anal sphincter injuries (OASIS): prevention, recognition, and repair. SOGC clinical practice guideline, no. 330. J Obstet Gynaecol Can. 2015;37:1131–49.
Sultan AH, Kamm MA, Hudson CN, Thomas JM, Bartram CI. Anal-sphincter disruption during vaginal delivery. N Engl J Med. 1993;329:1905–11.
Sultan AH, Loder PB, Bartram CI, Kamm MA, Hudson CN. Vaginal endosonography. New approach to image the undisturbed anal sphincter. Dis Colon Rectum. 1994;37:1296–129.
Timor-Tritsch IE, Monteagudo A, Smilen SW, Porges RF, Avizova E. Simple ultrasound evaluation of the anal sphincter in female patients using a transvaginal transducer. Ultrasound Obstet Gynecol. 2005;25:177–83.
Sultan AH. Editorial: obstetrical perineal injury and anal incontinence. J Patient Saf Risk Clinical Risk. 1999;5:193–6.
Roos AM, Abdool Z, Sultan AH, Thakar R. The diagnostic accuracy of endovaginal and transperineal ultrasound for detecting anal sphincter defects: the PREDICT study. Clin Radiol. 2011;66:597–604.
Valsky DV, Messing B, Petkova R, 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;29:195–204.
Ros C, Martínez-Franco E, Wozniak MM, et al. Postpartum two- and three-dimensional ultrasound evaluation of anal sphincter complex in women with obstetric anal sphincter injury. Ultrasound Obstet Gynecol. 2017;49:508–14.
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Hurni, Y., Maes, E., Avau, F. et al. Immediate postpartum assessment of the anal sphincter by endovaginal ultrasound: a new technical approach. Int Urogynecol J 33, 1689–1692 (2022). https://doi.org/10.1007/s00192-021-04956-y
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DOI: https://doi.org/10.1007/s00192-021-04956-y