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Immediate postpartum assessment of the anal sphincter by endovaginal ultrasound: An experimental study

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Abstract

Introduction and hypothesis

Obstetric anal sphincter injuries are frequently missed and carry a significant risk for the development of anal incontinence. Immediate postpartum endoanal ultrasound increases identification of these injuries but is rarely employed. We hypothesize that endovaginal ultrasound could be a feasible and easily available alternative sonographic tool to improve early diagnosis of anal sphincter tears.

Methods

We conducted a prospective experimental study including 160 primiparous women. Shortly after vaginal delivery, patients underwent clinical and sonographic perineal examinations. We analyzed the feasibility of anal sphincter assessment by endovaginal ultrasound and its potential contribution in the early diagnosis of anal sphincter injuries.

Results

Sonographic assessment of the anal sphincter was analyzable for 136 patients (85.0%). Causes of non-analyzability included air artifacts (6.9%), lack of distinction between the external anal sphincter and surrounding tissues (9.4%) and distortion artifacts (9.4%). Patients in the non-analyzable ultrasound subgroup were less likely to have delivered in a dorsal lithotomy position (62.5% vs. 85.3 %) and more likely to have had an episiotomy (33.3% vs. 14.0%), and their risk of sphincter injury was more frequently classified as “improbable” on clinical examination (91.7% vs. 61.0%). Ultrasounds were analyzable for 96.4% of patients clinically reported as having “possible” or “certain” sphincter injuries. The incidence of anal sphincter injury was 16.9% for clinical observation and 20.0% with associated sonographic examination.

Conclusions

Endovaginal ultrasound could be used as a complementary tool in assessment of the anal sphincter in high-risk patients. Its feasibility and easy availability make this technique a promising tool for improving the management of anal sphincter tears.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Perineal Clinic, CHU Saint-Pierre, Rue Haute 322, 1000, Brussels, Belgium

    Yannick Hurni, Elise Maes, Fiona Avau, Lauren Becu, Valerie Albert & Ann Pastijn

  2. Department of Obstetrics and Gynecology, Obstetric Unit, CHU Saint-Pierre, Brussels, Belgium

    Yannick Hurni, Elise Maes, Fiona Avau, Lauren Becu, Marie Buljubasic, Alix Danon, Leila Paquier & Giulia Garofalo

  3. Department of Obstetrics and Gynecology, Ultrasound Unit, CHU Saint-Pierre, Brussels, Belgium

    Giulia Garofalo

Authors
  1. Yannick Hurni
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  2. Elise Maes
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  3. Fiona Avau
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  4. Lauren Becu
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  5. Marie Buljubasic
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  6. Alix Danon
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  7. Leila Paquier
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  8. Giulia Garofalo
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  9. Valerie Albert
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  10. Ann Pastijn
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Contributions

Y Hurni: project development, data collection, data analysis, manuscript writing

E Maes: project development, data analysis, manuscript revision

F Avau: data collection, data analysis

L Becu: project development, data collection, data analysis

M Buljubasic: data collection, data analysis

A Danon: data collection, data analysis

L Paquier: data collection, data analysis

G Garofalo: project development, manuscript revision

V Albert: data analysis, manuscript revision

A Pastijn: supervision and coordination of the project, manuscript revision

Corresponding author

Correspondence to Yannick Hurni.

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Hurni, Y., Maes, E., Avau, F. et al. Immediate postpartum assessment of the anal sphincter by endovaginal ultrasound: An experimental study. Int Urogynecol J 33, 1639–1647 (2022). https://doi.org/10.1007/s00192-022-05191-9

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  • DOI: https://doi.org/10.1007/s00192-022-05191-9

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