Anal sphincter damage after vaginal delivery using three-dimensional endosonography

Area of Science:

• Obstetrics and Gynecology
• Pelvic Floor Disorders
• Diagnostic Imaging

Background:

• Perineal trauma during vaginal delivery is common.
• Assessing the functional impact of specific structure damage remains challenging.
• Three-dimensional endosonography offers a novel approach to visualize these injuries.

Purpose of the Study:

• To determine the incidence and functional consequences of external sphincter trauma.
• To compare trauma to the external sphincter with other perineal structures.
• To evaluate the utility of three-dimensional endosonography in assessing postpartum perineal trauma.

Main Methods:

• Fifty-five nulliparous women underwent three-dimensional anal endosonography, anal manometry, and continence questionnaires.
• Assessments were performed during mid-gestation and postpartum.
• Coronal imaging of the external anal sphincter was utilized.

Main Results:

• Postpartum trauma was identified in 29% of women with vaginal delivery.
• External sphincter trauma occurred in 11% and was associated with decreased squeeze pressure (P=.035) and increased incontinence scores (P=.02).
• Trauma to the puboanalis or transverse perineii alone did not significantly affect functional outcomes.

Conclusions:

• The incidence of external sphincter trauma is lower than previously reported but is the only functionally significant component.
• Three-dimensional endosonography is effective in assessing postpartum perineal trauma.
• Targeted assessment of the external anal sphincter is crucial for understanding functional deficits.