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Anovaginal distance and obstetric anal sphincter injury: a prospective observational study
INTRODUCTION AND HYPOTHESIS: No measurements are available for diagnosing the extent of obstetric lacerations. The primary aim of this study was to evaluate the relation between the anovaginal distance (AVD) measured with transperineal ultrasound immediately after delivery and external anal sphincte...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer International Publishing
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6511353/ https://www.ncbi.nlm.nih.gov/pubmed/30535980 http://dx.doi.org/10.1007/s00192-018-3838-5 |
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author | Pihl, Sofia Uustal, Eva Blomberg, Marie |
author_facet | Pihl, Sofia Uustal, Eva Blomberg, Marie |
author_sort | Pihl, Sofia |
collection | PubMed |
description | INTRODUCTION AND HYPOTHESIS: No measurements are available for diagnosing the extent of obstetric lacerations. The primary aim of this study was to evaluate the relation between the anovaginal distance (AVD) measured with transperineal ultrasound immediately after delivery and external anal sphincter injury. A secondary aim was to assess whether the palpated perineal thickness was associated with the AVD. METHODS: A prospective observational study of 150 primiparous women at the University Hospital, Linköping, Sweden. After vaginal delivery, initial inspection and palpation of the perineal thickness were performed by the midwife. The women were then divided into subgroups depending on the degree of the suspected perineal laceration. Transperineal ultrasound of the AVD was performed by a physician. Diagnostics of the perineal laceration were done according to standard care. RESULTS: Women with an external sphincter injury had a shorter AVD and shorter palpatory perineal thickness compared with women without anal sphincter injury. No external sphincter injuries were diagnosed when the AVD and/or palpation height was > 20 mm. The mean AVD in the group with probable second-degree laceration (n = 85) was 18.8 mm (95% CI 17.8–19.8), in suspected third-degree laceration (n = 33) 15.7 mm (95% CI 13.7–17.7) and in probable third-degree laceration (n = 32) 11.8 mm (95% CI 9.7–13.9) (p < 0.001). CONCLUSIONS: A short AVD could be a warning sign postpartum and should increase the awareness of possible external sphincter injury before suturing. An AVD of 20 mm seems to indicate a cutoff level of the occurrence of external sphincter injury, but this needs further evaluation. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00192-018-3838-5) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-6511353 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Springer International Publishing |
record_format | MEDLINE/PubMed |
spelling | pubmed-65113532019-05-28 Anovaginal distance and obstetric anal sphincter injury: a prospective observational study Pihl, Sofia Uustal, Eva Blomberg, Marie Int Urogynecol J Original Article INTRODUCTION AND HYPOTHESIS: No measurements are available for diagnosing the extent of obstetric lacerations. The primary aim of this study was to evaluate the relation between the anovaginal distance (AVD) measured with transperineal ultrasound immediately after delivery and external anal sphincter injury. A secondary aim was to assess whether the palpated perineal thickness was associated with the AVD. METHODS: A prospective observational study of 150 primiparous women at the University Hospital, Linköping, Sweden. After vaginal delivery, initial inspection and palpation of the perineal thickness were performed by the midwife. The women were then divided into subgroups depending on the degree of the suspected perineal laceration. Transperineal ultrasound of the AVD was performed by a physician. Diagnostics of the perineal laceration were done according to standard care. RESULTS: Women with an external sphincter injury had a shorter AVD and shorter palpatory perineal thickness compared with women without anal sphincter injury. No external sphincter injuries were diagnosed when the AVD and/or palpation height was > 20 mm. The mean AVD in the group with probable second-degree laceration (n = 85) was 18.8 mm (95% CI 17.8–19.8), in suspected third-degree laceration (n = 33) 15.7 mm (95% CI 13.7–17.7) and in probable third-degree laceration (n = 32) 11.8 mm (95% CI 9.7–13.9) (p < 0.001). CONCLUSIONS: A short AVD could be a warning sign postpartum and should increase the awareness of possible external sphincter injury before suturing. An AVD of 20 mm seems to indicate a cutoff level of the occurrence of external sphincter injury, but this needs further evaluation. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00192-018-3838-5) contains supplementary material, which is available to authorized users. Springer International Publishing 2018-12-10 2019 /pmc/articles/PMC6511353/ /pubmed/30535980 http://dx.doi.org/10.1007/s00192-018-3838-5 Text en © The Author(s) 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. |
spellingShingle | Original Article Pihl, Sofia Uustal, Eva Blomberg, Marie Anovaginal distance and obstetric anal sphincter injury: a prospective observational study |
title | Anovaginal distance and obstetric anal sphincter injury: a prospective observational study |
title_full | Anovaginal distance and obstetric anal sphincter injury: a prospective observational study |
title_fullStr | Anovaginal distance and obstetric anal sphincter injury: a prospective observational study |
title_full_unstemmed | Anovaginal distance and obstetric anal sphincter injury: a prospective observational study |
title_short | Anovaginal distance and obstetric anal sphincter injury: a prospective observational study |
title_sort | anovaginal distance and obstetric anal sphincter injury: a prospective observational study |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6511353/ https://www.ncbi.nlm.nih.gov/pubmed/30535980 http://dx.doi.org/10.1007/s00192-018-3838-5 |
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