Department of Obstetrics and Gynaecology, Croydon University Hospital, London Road, Croydon, CR7 7YE, UK.
Honorary Senior Lecturer, St George's University of London, London, UK.
Int Urogynecol J. 2022 Jun;33(6):1473-1479. doi: 10.1007/s00192-021-05051-y. Epub 2022 Feb 12.
Obstetric anal sphincter injuries (OASIs) that are missed at delivery can have long-term consequences. OASIs that are under-classified at delivery are likely to be inadequately repaired, resulting in a persistent anal sphincter defect. We aimed to identify women who have persistent defects on endoanal ultrasound, inconsistent with the original diagnosis, and compare the effect on St Mark's incontinence scores (SMIS). We also aimed to look for changes in numbers of under-classification over time.
Records of women attending a perineal clinic who had endoanal ultrasound from 2012 to 2020 were reviewed. Women who had a modified Starck score implying a defect greater than the classification [indicated by the depth of external anal sphincter or internal anal sphincter (IAS) defect] at delivery were identified.
A total of 1056 women with a diagnosis of 3a or 3b tears were included. Of these, 120 (11.36%) were found to have a defect greater than the original diagnosis and therefore were incorrectly classified at delivery. Women who had a 3b tear diagnosed at delivery, but had an IAS defect, had a significantly higher SMIS (p < 0.01). When comparing two 4-year periods, there was a significant improvement in the diagnosis of IAS tears.
Some women with OASIs that have under-classified OASIs are associated with worse anorectal symptoms. This is likely because of an incomplete repair. Some improvement in diagnosis of IAS tears has been noted. We propose improved training in OASIs can help reduce the number of incorrectly classified tears and improve repair.
分娩时漏诊的产科肛门括约肌损伤（OASIs）可能会产生长期后果。分娩时分类不足的 OASIs 可能修复不充分，导致持续的肛门括约肌缺陷。我们旨在确定在 endoanal 超声上存在与原始诊断不一致的持续性缺陷的女性，并比较 St Mark 失禁评分（SMIS）的影响。我们还旨在研究随着时间的推移，分类不足的数量变化。
回顾了 2012 年至 2020 年在会阴诊所接受 endoanal 超声检查的女性的记录。确定了分娩时的改良 Starck 评分表明存在大于（由外部肛门括约肌或内部肛门括约肌（IAS）缺陷的深度指示）的缺陷的女性。
共纳入 1056 例 3a 或 3b 撕裂的女性。其中，120 例（11.36%）存在大于原始诊断的缺陷，因此在分娩时分类错误。分娩时诊断为 3b 撕裂但存在 IAS 缺陷的女性的 SMIS 明显更高（p<0.01）。比较两个 4 年期间，IAS 撕裂的诊断明显改善。
一些 OASIs 分类不足的 OASIs 女性存在更严重的肛肠症状。这可能是由于修复不完整。IAS 撕裂的诊断有所改善。我们建议加强 OASIs 的培训可以帮助减少错误分类的撕裂数量并改善修复。
