Postpartum endoanal ultrasound findings in primiparous women after vaginal delivery.
BACKGROUND
Natural childbirth is regarded as the most frequent cause of anal sphincter defects. The majority of obstetric injuries are detectable only by anal endosonography (AES), in from 6.8% to 35% of women after vaginal delivery.


OBJECTIVE
To evaluate prospectively anal sphincters in primiparous women in the first days after delivery to estimate the prevalence of anal sphincter defects and to correlate selected risk factors with the recognized injuries.


METHODS
A total of 112 consecutive primiparous women aged 19-40 years (mean 29.3 years) underwent three-dimensional (3D) AES with the use of a BK Medical scanner Profocus 2202 in the first weeks after delivery.


RESULTS
Twelve tears (10.7%) in the perineum, including three extending to anal sphincters (2.6%) were found on AES. As many as 86 (76.8%) women had medio-lateral episiotomies due to the practice pattern in our hospital or as a consequence of obstetric factors. The statistical analysis did not prove a significant association between diagnosed injuries and episiotomy (P=0.73), nor a traumatic effect of epidural anesthesia, fetus head circumference > or =34 cm, or birth weight > or =3525 g.


CONCLUSIONS
Anal sphincter tears following childbirth were found in only 2.6% of primiparous women, suggesting that vaginal delivery might not imply high risk of pelvic floor damage as has previously been assumed. The results do not confirm that medio-lateral episiotomy is conducive to obstetric anal sphincter defects.
Sudoł-Szopinńska
Iwona
I
Department of Diagnostic Imaging, Warsaw Medical University, Poland. iwsud@ciop.pl
Radkiewicz
Justyna
J
Szopiński
Tomasz
T
Panorska
Anna K
AK
Jakubowski
Wiesław
W
Kawka
Jarosław
J
D000328:Adult; D001003:Anal Canal / Q000000981:diagnostic imaging* / Q000293:injuries*; D036861:Delivery, Obstetric; D019160:Endosonography / Q000379:methods*; D004841:Episiotomy; D005113:Extraction, Obstetrical; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D007744:Obstetric Labor Complications / Q000000981:diagnostic imaging*; D010502:Perineum / Q000000981:diagnostic imaging* / Q000293:injuries*; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D011247:Pregnancy; D015995:Prevalence; D011446:Prospective Studies; D011644:Puerperal Disorders / Q000000981:diagnostic imaging; D012307:Risk Factors