Prospective evaluation of perineal ultrasound in the delivery room to improve the diagnosis of Obstetric Anal Sphincter Injuries (OASIS) (A Randomized Controlled trial)

Abstract

Background: During childbirth, many women develop trauma to the perineum, these tears can involve the perineal skin, the pelvic floor muscles, the external and internal anal sphincter muscles as well as the rectal mucosa. Objectives: To Evaluate the role of routine perineal scan using 2D ultrasound immediately after delivery to diagnose hidden perineal trauma that might affect patient's fecal continence. Patients and Methods: A prospective Randomized controlled Clinical Trial to evaluate the use of perineal ultrasound in delivery room prior to repair of obstetric trauma to improve detection rates of OASIS was conducted at the department of Obstetrics & Gynecology- Ain Shams University Hospital, Cairo, Egypt, from July 2017 to April 2019. The patients were assessed for eligibility after vaginal delivery by the attendant obstetrician. Patients with history of anal incontinence, visible 3rd or 4th degree perineal tear, previous anal sphincter injuries or anal surgery were excluded from the study. Only patients with a visible 2nd degree perineal tear were included in the study. Results: The studied patients were with the following means and SD age 27.34 ± 3.78 (range: 17 – 37) for control group and 24.82 ± 3.43 (range: 18-34) for study group, Birth weight 3228.78 ± 242.28 (range: 2650 – 3650) for control group and 3268.22 ± 243.81 (range: 2750 – 3900) for study group, 16 patients (6.5%) had outlet forcep delivery in control group and 18 patients (7.3%) in study group. 38 (15.5%) patients in control group had induction of labor in control group and 43 patients (17.6%) in study group. 96 patients in control group had a mediolateral episiotomy and 117 patients in the study group. Conclusion: In conclusion, although, 2D TPUS provides a valuable information about perineal structures; In the current study 2D TPUS (Endovaginal ultrasound) showed comparable results to clinical examination for assessing OASIS. Further research is needed to assess the reliability of perineal ultrasound in evaluating ASC and its role in postpartum evaluation of OASIS. Transperineal U/S needs to be compared to endoaual ultrasound.