干旱区生态环境知识资源中心(Arid): Underdiagnosis of internal anal sphincter trauma following vaginal delivery

Arid

DOI	10.1002/uog.26049
	Underdiagnosis of internal anal sphincter trauma following vaginal delivery
	O'Leary, B. D.; Kelly, L.; Fitzpatrick, M.; Keane, D. P.
通讯作者	O'Leary, BD
来源期刊	ULTRASOUND IN OBSTETRICS & GYNECOLOGY
ISSN	0960-7692
EISSN	1469-0705
出版年	2023
卷号	61 期号:2 页码:251-256
英文摘要	ObjectiveDamage to the anal sphincter during childbirth remains the leading cause of fecal incontinence in women. Defects in the internal (IAS) or external anal sphincter, alongside symptoms and sphincter tone, will generally dictate the suggested mode of delivery in any successive pregnancy. This study aimed to examine using endoanal ultrasonography the prevalence of IAS damage in women referred with Grade-3a or -3b obstetric anal sphincter injury (OASI) in a tertiary-referral perineal clinic. MethodsThis was a retrospective observational study of all women referred to a tertiary-referral perineal clinic after primary repair of OASI (Grade 3a-c, 4) diagnosed for the first time following vaginal delivery between January 2016 and December 2019, inclusive. Women were assessed using the Wexner bowel continence questionnaire, digital examination of sphincter tone and endoanal ultrasound. Injuries in each sphincter were classified as a scar (<= 30 degrees) or defect (> 30-90 degrees or > 90 degrees) on endoanal imaging in the axial plane. Results In total, 615 women were referred following primary repair of OASI. Sonographic evidence of damage to the IAS was seen in 9.1% (46/506) of women diagnosed with a Grade-3a/3b injury. In women referred with a Grade-3a/3b tear, symptom scores were statistically higher (P = 0.025) in those with an IAS defect > 30 degrees compared to those with an intact or scarred IAS, although the median score was zero in both groups. The proportion of women in each group with severe symptoms (score > 9) was similar (2.6% vs 6.5%; P = 0.148). Among women referred with a Grade-3a/3b tear, sphincter tone was reduced more frequently in those with a defect of the IAS than in those with an intact or scarred IAS (52.2% vs 11.7%; odds ratio, 8.14 (95% CI, 4.26-15.67); P < 0.001). Regardless of the reason for referral, women with reduced sphincter tone on rectal examination were four times as likely to have had an IAS defect > 30 degrees than were those with normal resting tone (risk ratio, 4.58 (95% CI, 3.25-6.45); P < 0.001). ConclusionsOne in 11 women diagnosed with a Grade-3a or -3b tear have evidence of damage to their IAS on endoanal ultrasound. Damage to this muscle is linked to fecal incontinence in women and can have a significant impact on the planning of any future deliveries. This study highlights the importance of established perineal clinics with access to ultrasound. Nonetheless, if reduced sphincter tone is felt on rectal examination, a clinician should have a high index of suspicion for an occult IAS injury. (c) 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
英文关键词	birth trauma endoanal ultrasound fecal incontinence OASI obstetric anal sphincter injury perineal trauma
类型	Article
语种	英语
开放获取类型	hybrid, Green Published
收录类别	SCI-E
WOS记录号	WOS:000951258800013
WOS关键词	FECAL INCONTINENCE ; INJURIES OASIS ; PRIMARY REPAIR ; CONTINENCE ; CLASSIFICATION ; TEARS
WOS类目	Acoustics ; Obstetrics & Gynecology ; Radiology, Nuclear Medicine & Medical Imaging
WOS研究方向	Acoustics ; Obstetrics & Gynecology ; Radiology, Nuclear Medicine & Medical Imaging
资源类型	期刊论文
条目标识符	http://119.78.100.177/qdio/handle/2XILL650/398944
推荐引用方式 GB/T 7714	O'Leary, B. D.,Kelly, L.,Fitzpatrick, M.,et al. Underdiagnosis of internal anal sphincter trauma following vaginal delivery[J],2023,61(2):251-256.
APA	O'Leary, B. D.,Kelly, L.,Fitzpatrick, M.,&Keane, D. P..(2023).Underdiagnosis of internal anal sphincter trauma following vaginal delivery.ULTRASOUND IN OBSTETRICS & GYNECOLOGY,61(2),251-256.
MLA	O'Leary, B. D.,et al."Underdiagnosis of internal anal sphincter trauma following vaginal delivery".ULTRASOUND IN OBSTETRICS & GYNECOLOGY 61.2(2023):251-256.