Diagnosis of anal sphincter tears by postpartum endosonography to predict fecal incontinence.
OBJECTIVE
To determine whether anal endosonography immediately after vaginal delivery can predict subsequent fecal incontinence.


METHODS
We studied nulliparas who delivered vaginally and had no anal sphincter tears (third- or fourth-degree perineal tears) diagnosed clinically by endosonography before any suture of the perineum. The sonographer was unaware of delivery details and the obstetrician and the women were not informed of endosonography results. Therefore, the suture of the perineum and the outcomes were not influenced by sonographer's diagnoses. Three months after delivery, we assessed fecal incontinence by self-administered questionnaires.


RESULTS
Clinically undetected tears of the anal sphincter were diagnosed by anal endosonography in 42 of 150 women (28%). The external anal sphincter alone was involved in 30 women (20%), the internal anal sphincter alone in two (1.3%), and both in ten (7%). The postal questionnaire was returned by 144 women. Incontinence was reported by 22 (15%, 95% confidence interval [CI] 10%, 22%), consisting mainly of incontinence to flatus only (16 of 22, 73%, 95% CI 50%, 89%). Clinically undetected anal sphincter tears diagnosed by endosonography were associated with incontinence 3 months after delivery (odds ratio [OR] 8.8; 95% CI 2.9, 26.5). The sensitivity of anal endosonography was 68% (95% CI 49%, 88%) and the positive predictive value 37% (95% CI 22%, 51%).


CONCLUSIONS
Anal endosonography immediately after vaginal delivery allows diagnosis of clinically undetected anal sphincter tears that might be associated with subsequent fecal incontinence.
Faltin
D L
DL
Department of Gynecology and Obstetrics, University Hospital, Geneva, Switzerland. daniel.faltin@hcuge.ch
Boulvain
M
M
Irion
O
O
Bretones
S
S
Stan
C
C
Weil
A
A
D000328:Adult; D001003:Anal Canal / Q000000981:diagnostic imaging* / Q000293:injuries*; D005242:Fecal Incontinence / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D006801:Humans; D007744:Obstetric Labor Complications / Q000000981:diagnostic imaging*; D049590:Postpartum Period; D011237:Predictive Value of Tests; D011247:Pregnancy; D011644:Puerperal Disorders / Q000175:diagnosis* / Q000209:etiology; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires; D014463:Ultrasonography