Endoanal ultrasound for detection of sphincter defects following childbirth

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12 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)627-635
Number of pages9
JournalInternational Urogynecology Journal and Pelvic Floor Dysfunction
Volume24
Issue number4
DOIs
StatePublished - Apr 1 2013

Keywords

  • Anal sphincter defects
  • Endoanal sonography
  • Occult anal sphincter injury

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Urology

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