Abstract
PurposeThe aim of the study was to investigate the association between the initial grade of obstetrical anal sphincter injury (OASIS), and Wexner score parameters, with ultrasonographic findings by endoanal ultrasound (EAUS, golden standard) and transperineal ultrasound (TPUS) 6 months post-partum.MethodsFifty-nine women after primary repair of OASIS were included at Helsingborg Hospital, Sweden, 2016–2017. Six months post-partum the women filled in a questionnaire regarding symptoms of anal incontinence by the Wexner score and were scanned with EAUS and TPUS (resting state and contracting state) for classification of the residual defect by a modified Starck score.ResultsCorrelations were found between the OASIS grade and residual defects; length (rs = 0.41, P = 0.003), depth (rs = 0.38, P = 0.006) and angle (rs = 0.40, P = 0.004) of the external anal sphincter (EAS) measured with TPUS in resting state. Using EAUS, correlation between OASIS grade and EAS depth (rs = 0.35, P = 0.007) and angle (rs = 0.37, P = 0.004) were similar, but there was no correlation with length (rs = 0.20, P = 0.14). Between incontinence to gas and the angle of the residual defect in the IAS using TPUS in resting state, correlation was moderate (rs = 0.42, P = 0.003). Regarding incontinence to liquid stool, measurements by TPUS in resting state of EAS residual defect depth (rs = 0.46, P < 0.001) and angle (rs = 0.44, P = 0.001) also correlated moderately. Both corresponding correlations using EAUS were weaker.ConclusionDefects measured with EAUS and TPUS six months post-partum correlated to initial OASIS grade and symptoms of anal incontinence. Specific symptoms correlated with specific anatomical defects, and TPUS was not an inferior method to EAUS.
Highlights
Obstetric injuries to the anal sphincter (OASIS) complex affect approximately 5% of women in conjunction with childbirth [1,2,3,4], with the main risk factors being nulliparityThe anal sphincter complex constitutes of the internal anal sphincter (IAS), consisting of smooth muscle and the external anal sphincter (EAS), consisting of skeletal muscle
Other ultrasound modalities are on the rise, recently three-dimensional transperineal ultrasound (TPUS) was presented as a screening tool in assessment of residual defects after OASIS [12], We have previously showed a strong a correlation between Endoanal ultrasound (EAUS) and TPUS in the assessment of residual defects six months after primary suturing of OASIS [13], the TPUS score showed a strong correlation with EAUS score during both pelvic floor relaxation and contraction
The strongest correlation between EAUS and TPUS was regarding the depth of the injury
Summary
Obstetric injuries to the anal sphincter (OASIS) complex affect approximately 5% of women in conjunction with childbirth [1,2,3,4], with the main risk factors being nulliparityThe anal sphincter complex constitutes of the internal anal sphincter (IAS), consisting of smooth muscle and the external anal sphincter (EAS), consisting of skeletal muscle. Obstetric injuries to the anal sphincter (OASIS) complex affect approximately 5% of women in conjunction with childbirth [1,2,3,4], with the main risk factors being nulliparity. Data is inconsistent regarding both the correlation between endosonographically defined defects and of, and the initial grade of defect and symptoms of fecal incontinence [9,10,11]. Endoanal ultrasound (EAUS) is considered gold standard in ultrasonographic assessment of OASIS. Significant correlations between EAUS and TPUS were found when assessing the depth, length and angle of the defect, regarding both the EAS and IAS. The strongest correlation between EAUS and TPUS was regarding the depth of the injury (rs = 0.71, P < 0.001)
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