Transperineal Ultrasound Immediately After Birth to Predict Postpartum Anorectal Dysfunction: A Prospective Cohort...

Area of Science:

• Obstetrics and Gynecology
• Pelvic Floor Disorders
• Medical Imaging

Background:

• Postpartum anal incontinence (AI) and constipation are common complications following vaginal delivery.
• Identifying predictors of these conditions is crucial for effective prevention and management.
• Transperineal ultrasound (TPUS) offers a non-invasive method to assess pelvic floor structures immediately postpartum.

Purpose of the Study:

• To investigate the correlation between immediate postpartum transperineal ultrasound (TPUS) findings and the development of anal incontinence (AI) and constipation.
• To determine if specific TPUS-detected pelvic floor defects predict postpartum AI or constipation.

Main Methods:

• A prospective cohort study involving 182 women who delivered vaginally at term.
• Participants completed validated questionnaires for AI and constipation symptoms at 6 weeks postpartum.
• Transperineal ultrasound (TPUS) was performed immediately after delivery to assess for levator avulsion, anal sphincter defects, genital hiatus dimensions, and rectovaginal septum defects.

Main Results:

• A significant prevalence of postpartum AI (60%) and constipation (43%) was observed.
• Levator avulsion (20.3%) and external anal sphincter defects (46%) were common findings on TPUS.
• Multivariate analysis revealed levator avulsion as the sole independent sonographic predictor of postpartum AI (aOR=2.57), while other TPUS findings and constipation were not associated with AI.

Conclusions:

• Immediate postpartum detection of levator avulsion via transperineal ultrasound is a significant predictor of subsequent anal incontinence.
• Ultrasound assessment of the anal sphincter, genital hiatus, and rectovaginal septum immediately after birth did not reliably predict postpartum AI or constipation.
• TPUS for levator avulsion may aid in identifying women at higher risk for postpartum anal incontinence.