title: Three-dimensional transperineal ultrasound findings associated with anal incontinence after intrapartum sphincter tears in primiparous women.
abstract: OBJECTIVE
  Three-dimensional transperineal sonography (3D-TPS) performed in women following third- or fourth-degree intrapartum tears repaired with the overlapping technique demonstrates characteristic signs. The aim of this study was to investigate the correlation of these signs with clinical complaints of incontinence.
  
  
  METHODS
  This was a prospective observational study. Sixty primiparous women underwent 3D-TPS 3-42 (mean, 10.6) months after surgical repair of third- or fourth-degree postpartum sphincter tears with the overlapping technique and were evaluated for clinical degree of incontinence using the St Mark's Incontinence Score (SMIS) questionnaire. The following signs were assessed on 3D-TPS: interruption of the internal anal sphincter or external anal sphincter, 'half moon' sign, changes in the mucosal folds and thickening of the external anal sphincter in the area of sphincter repair. As a comparison group, 27 primiparous women after normal vaginal delivery, without clinically recognized anal sphincter tears, were evaluated similarly, 3-37 (mean, 9.9) months postpartum.
  
  
  RESULTS
  Abnormal sonographic signs were apparent in 35 (58.3%) of 60 women in the study group, and 39 (65%) of 60 had some clinical complaints of incontinence 3-42 months after delivery, most of a mild degree. Higher SMIS results were found in women of the study group than in those of the comparison group (mean (SD) 2.80 (0.481) vs. 1.15 (0.365); P = 0.018). The rates of incontinence were similar between the women in the study group with normal ultrasound findings and the women in the comparison group (9/25 vs. 10/27; relative risk (RR) = 0.97, 95% CI, 0.47-1.97).
  
  
  CONCLUSIONS
  Sonographic signs of anal sphincter tear and repair had disappeared at follow-up examination in almost half of the patients, and therefore this examination should be deferred from the early postpartum period. A substantial proportion of women report some complaint of incontinence after sphincter repair, most of a slight degree. Such complaints are associated with abnormal 3D-TPS findings at follow up, while in women with a normal 3D-TPS scan the rate of incontinence complaints is similar to that in women after normal delivery.
authors.affiliation: Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Centers, Mount Scopus, Jerusalem, Israel. valskydan@hadassah.org.il
authors.forename: D V
authors.initials: DV
authors.lastname: Valsky
authors.forename: S M
authors.initials: SM
authors.lastname: Cohen
authors.forename: M
authors.initials: M
authors.lastname: Lipschuetz
authors.forename: D
authors.initials: D
authors.lastname: Hochner-Celnikier
authors.forename: S
authors.initials: S
authors.lastname: Yagel
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000000981:diagnostic imaging* / Q000293:injuries / Q000601:surgery; D036861:Delivery, Obstetric / Q000009:adverse effects; D019160:Endosonography / Q000379:methods*; D005242:Fecal Incontinence / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D022125:Lacerations / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D007744:Obstetric Labor Complications / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D010298:Parity; D010502:Perineum / Q000000981:diagnostic imaging* / Q000293:injuries / Q000601:surgery; D011247:Pregnancy; D011446:Prospective Studies; D011795:Surveys and Questionnaires