University Hospital Lewisham, London, UK; Urogynaecology & Pelvic Floor Reconstruction Unit, Croydon University Hospital, Surrey, UK.
Urogynaecology & Pelvic Floor Reconstruction Unit, Croydon University Hospital, Surrey, UK; St George's University of London, UK.
Eur J Obstet Gynecol Reprod Biol. 2022 Apr;271:260-264. doi: 10.1016/j.ejogrb.2022.02.182. Epub 2022 Mar 2.
When obstetric anal sphincter injuries are identified, it is crucial that the defects are repaired appropriately to achieve a better outcome. Although the presence of an intact anal sphincter is not the sole mechanism for maintaining continence, and not all women with an anal sphincter defect are symptomatic, there is an association between sphincter defects and anal incontinence. Our aim was to evaluate whether transperineal ultrasound (TPUS) is useful in assessing anal sphincter integrity immediately following primary repair of obstetric anal sphincter injuries (OASIs).
This is a prospective observational study of women who sustained OASIs during their first vaginal delivery. Three dimensional (3D) TPUS was performed immediately after repair of OASIs to identify anal sphincter defects. A repeat TPUS was performed 12 weeks following repair.
21 women sustained OASIs of whom 20 (95%) attended follow up. Eight (40%) had a grade 3a tear and 12 (60%) a 3b tear. 8/20 (40%) women had residual external anal sphincter (EAS) defects identified by TPUS immediately after repair. Of these eight defects, six (75%) persisted at 12 weeks postpartum. No new defects were seen at follow up among the twelve women in whom no defect was seen immediately following the repair. Six residual EAS defects were found at 12 weeks postpartum. An EAS defect at 12 weeks postpartum was associated with anal incontinence (p = 0.04). Women with 3b tears were more likely to have anal incontinence (AI) and residual sonographic EAS defects when compared with 3a tears but this was not statistically significant.
Women who had no TPUS defect detected immediately following primary repair of OASIs, remained as such at 12 weeks postpartum. Of those in whom a defect was seen immediately after repair, it persisted in 75% of cases at 12 weeks. We believe that the value of TPUS immediately after repair appears to be limited and would need to be defined if it were to be considered for routine practice. Further research on its role immediately after repair of major tears (Grade 3C/4) is needed. In addition, performing ultrasound would require widespread training of obstetricians to develop expertise. This highlights the importance of adequate training of obstetricians in OASI repair.
当发现产科肛门括约肌损伤时，适当地修复缺陷以获得更好的结果至关重要。尽管完整的肛门括约肌并不是保持节制的唯一机制，并且并非所有肛门括约肌缺陷的女性都有症状，但括约肌缺陷与肛门失禁之间存在关联。我们的目的是评估经会阴超声（TPUS）是否可用于评估初次修复产科肛门括约肌损伤（OASIs）后肛门括约肌的完整性。
这是一项对初次阴道分娩时发生 OASI 的女性进行的前瞻性观察性研究。在修复 OASI 后立即进行三维（3D）TPUS 以识别肛门括约肌缺陷。修复后 12 周重复进行 TPUS。
21 名女性发生 OASI，其中 20 名（95%）接受了随访。8 名（40%）有 3a 级撕裂，12 名（60%）有 3b 级撕裂。20 名女性中有 8 名（40%）在修复后立即通过 TPUS 发现残余的外部肛门括约肌（EAS）缺陷。在这些缺陷中，有 6 个（75%）在产后 12 周时仍然存在。在修复后未见缺陷的 12 名女性中，在随访中未发现新的缺陷。产后 12 周时发现 6 个残余 EAS 缺陷。产后 12 周时的 EAS 缺陷与肛门失禁（p=0.04）相关。与 3a 撕裂相比，3b 撕裂的女性更有可能出现肛门失禁（AI）和残余超声 EAS 缺陷，但无统计学意义。
初次修复 OASI 后未发现 TPUS 缺陷的女性在产后 12 周时仍未发现缺陷。在修复后立即发现缺陷的女性中，有 75%的病例在 12 周时仍然存在。我们认为，修复后立即进行 TPUS 的价值似乎有限，如果要将其纳入常规实践，则需要进一步明确。需要进一步研究其在 3C/4 级大撕裂中的作用。此外，进行超声检查需要对产科医生进行广泛的培训以发展专业知识。这突显了对产科医生进行 OASI 修复充分培训的重要性。
