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Chen B, Yi Y, Zhang C, Yan Y, Wang X, Shui W, Zhou M, Yang G, Ying T. Automatic anal sphincter integrity detection from ultrasound images via convolutional neural networks. Technol Health Care 2024:THC240569. [PMID: 39213111 DOI: 10.3233/thc-240569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
BACKGROUND The anal sphincter complex comprises the anal sphincter and the U-shaped deep and superficial puborectalis muscle. As an important supporting structure of the posterior pelvic floor, together with its surrounding tissues and muscles, the anal sphincter complex maintains the normal physiological functions of defecation and continence. OBJECTIVE The plane required for diagnosing anal sphincter injury and the diagnosis of anal sphincter integrity through pelvic floor ultrasound are highly dependent on sonographers' experience. We developed a deep learning (DL) tool for the automatic diagnosis of anal sphincter integrity via pelvic floor ultrasound. METHODS A 2D detection network was trained to detect the bounding box of the anal sphincter. The pelvic floor ultrasound image and its corresponding oval mask were input into a 2D classification network to determine the integrity of the anal sphincter. The average precision (AP) and intersection over union (IoU) were used to evaluate the performance of anal sphincter detection. Receiver operating characteristic (ROC) analysis was used to evaluate the performance of the classification model. RESULTS The Pearson correlation coefficients (r values) of the topmost and bottommost layers detected by the CNN and sonographers were 0.932 and 0.978, respectively. The best DL model yielded the highest area under the curve (AUC) of 0.808 (95% CI: 0.698-0.921) in the test cohort. The results from the CNN agreed well with the diagnostic results of experienced sonographers. CONCLUSIONS We proposed, for the first time, a CNN to obtain the plane required for diagnosing anal sphincter injury on the basis of pelvic floor ultrasound and for preliminarily diagnosing anal sphincter injury.
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Affiliation(s)
- Bin Chen
- Department of Ultrasound in Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Institute of Ultrasound in Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Ultrasound in Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yinqiao Yi
- Shanghai Key Laboratory of Magnetic Resonance, School of Physics and Electronic Science, East China Normal University, Shanghai, China
- Department of Ultrasound in Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chengxiu Zhang
- Shanghai Key Laboratory of Magnetic Resonance, School of Physics and Electronic Science, East China Normal University, Shanghai, China
| | - Yulin Yan
- Department of Ultrasound in Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Institute of Ultrasound in Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xia Wang
- Department of Ultrasound in Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Institute of Ultrasound in Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wen Shui
- Department of Ultrasound in Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Institute of Ultrasound in Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Minzhi Zhou
- Department of Ultrasound in Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Institute of Ultrasound in Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guang Yang
- Shanghai Key Laboratory of Magnetic Resonance, School of Physics and Electronic Science, East China Normal University, Shanghai, China
| | - Tao Ying
- Department of Ultrasound in Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Institute of Ultrasound in Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Muro S, Chikazawa K, Delancey JOL, Akita K. Skeletal Muscle Complex Between the Vagina and Anal Canal: Implications for Perineal Laceration. Int Urogynecol J 2024:10.1007/s00192-024-05851-y. [PMID: 38995424 DOI: 10.1007/s00192-024-05851-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 06/02/2024] [Indexed: 07/13/2024]
Abstract
INTRODUCTION AND HYPOTHESIS The anatomy of the skeletal muscles located between the vagina and anus is important during complex obstetric laceration reconstructions. We aimed to clarify the composition of skeletal muscles located between the vagina and anal canal and their three-dimensional configuration relevant to perineum repair. METHODS This observational study involved ten female cadavers. An anatomical dissection was performed to observe the muscles around the vagina and anal canal. Immunohistological analysis of the midsagittal section was performed to clarify the composition of the muscles, and dissection was performed to correspond to the cross-section. Wide-range serial sectioning and three-dimensional reconstruction were used to support these findings histologically and visualize the three-dimensional arrangement. RESULTS The region between the vagina and anal canal included the anterior part of the external anal sphincter, superficial transverse perineal muscle approaching from the lateral side, and levator ani, located cranially. They converge three-dimensionally in the median from each direction, forming a muscle complex between the vagina and anal canal. CONCLUSIONS The medial region between the vagina and anal canal in those giving birth includes a skeletal muscle complex formed by the confluence of the external anal sphincter, anterior bundle of the levator ani, and superficial transverse perineal muscle. In cases of severe perineal lacerations, these muscles could be injured. The anatomical knowledge that a part of the levator ani forms a muscle sling anterior to the anal canal is particularly important for obstetricians and gynecologists repairing obstetric lacerations and treating pelvic floor disorders.
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Affiliation(s)
- Satoru Muro
- Department of Clinical Anatomy, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan.
| | - Kenro Chikazawa
- Department of Obstetrics and Gynecology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - John O L Delancey
- University of Michigan Medical School, L4208 UHS, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Keiichi Akita
- Department of Clinical Anatomy, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan
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Jaufuraully SR, Salvadores Fernandez C, Abbas N, Desjardins A, Tiwari MK, David AL, Siassakos D. A sensorised surgical glove to improve training and detection of obstetric anal sphincter injury: A preclinical study on a pig model. BJOG 2024; 131:1129-1135. [PMID: 38247347 DOI: 10.1111/1471-0528.17762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 12/06/2023] [Accepted: 01/02/2024] [Indexed: 01/23/2024]
Abstract
OBJECTIVE To create a sensorised surgical glove that can accurately identify obstetric anal sphincter injury to facilitate timely repair, reduce complications and aid training. DESIGN Proof-of-concept. SETTING Laboratory. SAMPLE Pig models. METHODS Flexible triboelectric pressure/force sensors were mounted onto the fingertips of a routine surgical glove. The sensors produce a current when rubbed on materials of different characteristics which can be analysed. A per rectum examination was performed on the intact sphincter of pig cadavers, analogous to routine examination for obstetric anal sphincter injuries postpartum. An anal sphincter defect was created by cutting through the vaginal mucosa and into the external anal sphincter using a scalpel. The sphincter was then re-examined. Data and signals were interpreted. MAIN OUTCOME MEASURES Sensitivity and specificity of the glove in detecting anal sphincter injury. RESULTS In all, 200 examinations were performed. The sensors detected anal sphincter injuries in a pig model with sensitivities between 98% and 100% and a specificity of 100%. The current produced when examining an intact sphincter and sphincter with a defect was significantly different (p < 0.001). CONCLUSION In this preliminary study, the sensorised glove accurately detected anal sphincter injury in a pig model. Future plans include its clinical translation, starting with an in-human study on postpartum women, to determine whether it can accurately detect different types of obstetric anal sphincter injury in vivo.
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Affiliation(s)
- Shireen R Jaufuraully
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Carmen Salvadores Fernandez
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
- Nanoengineered Systems Laboratory, Mechanical Engineering, University College London, London, UK
| | - Nadine Abbas
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Adrien Desjardins
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Manish K Tiwari
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
- Nanoengineered Systems Laboratory, Mechanical Engineering, University College London, London, UK
| | - Anna L David
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Dimitrios Siassakos
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
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Eshkoli T, Baumfeld Y, Yohay Z, Binyamin Y, Speigel E, Dym L, Weintraub AY. Is epidural analgesia an independent risk factor for OASIS? A population-based cohort study. Arch Gynecol Obstet 2024; 309:2499-2504. [PMID: 37454350 DOI: 10.1007/s00404-023-07150-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 07/07/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION To evaluate whether epidural analgesia is an independent risk factor for OASIS. METHODS A population-based cohort study including all women who delivered by spontaneous vaginal delivery or by instrumental delivery beyond 24 weeks gestation was conducted. Deliveries occurred between 1988 and 2016 at a large university tertiary medical center. Women with multiple gestations and those lacking prenatal care were excluded from the analysis. RESULTS During the study period, 252,542 women delivered at the Soroka University Medical Center and met the inclusion criteria. Of these, 583 (0.23%) were diagnosed with OASIS. Women with OASIS were more likely to be younger, nulliparous, with suspected fetal macrosomia, had higher rates of labor induction and vacuum extraction delivery, higher rates of conceiving after infertility treatments, more advanced gestational age at delivery, higher mean birth weight, higher rates of post-partum hemorrhage and need for blood transfusions. Use of epidural analgesia during pregnancy was significantly high among the OASIS group. Rates of episiotomy were not significantly different between the groups. Using a multimodal logistic regression model, after controlling for vacuum delivery, large for gestational age, nulliparity, gestational age, ethnicity, maternal age, induction of labor, fertility treatments, non-reassuring fetal heart rate and non-progressive second stage of labor, epidural analgesia was found to be significantly associated with OASIS. CONCLUSION Epidural analgesia was found to be an independent risk factor for OASIS in our population.
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Affiliation(s)
- Tamar Eshkoli
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Reger Street, P.O.B 151, 84101, Beersheba, Israel.
| | - Yael Baumfeld
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Reger Street, P.O.B 151, 84101, Beersheba, Israel
| | - Zehava Yohay
- Department of Anesthesiology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Yair Binyamin
- Department of Anesthesiology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Efrat Speigel
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Reger Street, P.O.B 151, 84101, Beersheba, Israel
| | - Lianne Dym
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Reger Street, P.O.B 151, 84101, Beersheba, Israel
| | - Adi Y Weintraub
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Reger Street, P.O.B 151, 84101, Beersheba, Israel
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Zhang M, Wu J, Lin X, Mu L, Ma G, Zhang Z, Shi J, He S, Ma Y, Shang N, Wang H, Ran S, Wang X, Tian J, Qu E, Zhang X. Quality assessment of transperineal ultrasound in Chinese tertiary medical centers: a multicenter study. Quant Imaging Med Surg 2023; 13:6952-6964. [PMID: 37869356 PMCID: PMC10585525 DOI: 10.21037/qims-23-176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 08/14/2023] [Indexed: 10/24/2023]
Abstract
Background Transperineal ultrasound (TPUS) is a vital examination method for diagnosing pelvic floor diseases. However, the quality of TPUS largely relies on the operator's experience, and there is a lack of studies on the evaluation of TPUS quality. Therefore, the objective of this study was to assess the quality of TPUS examinations in Chinese tertiary medical centers. Methods This multicenter study conducted in 44 Chinese tertiary medical centers recruited postpartum women between September 2020 and September 2021. All participants underwent a standardized inquiry and TPUS examination. The participating centers were required to submit 5 parts of ultrasound data to the National Ultrasound Quality Control Center: 2-dimensional images at rest, 2-dimensional images at strain; 4-dimensional images of the levator ani hiatus; 4-dimensional images of the levator ani muscle; and 4-dimensional images of the anal sphincter. Quality assessment was performed by 2 experts with more than 5 years of experience in TPUS, and the reasons for nonqualification were stated. Results In this study, 31 hospitals that were distributed across 20 provinces in China were included, submitting 2,251 cases in total. The overall qualified rate ranged from 12.00% to 86.92%. In each part, the qualified rate of 2-dimensional images at rest, 2-dimensional images at straining, levator ani hiatus, levator ani muscle, and anal sphincter was 94.27% (2,122/2,251), 78.54% (1,768/2,251), 85.52% (1,925/2,251), 93.03% (2,094/2,251), and 88.09% (1,983/2,251), respectively. Most of the nonqualified images belonged to 2-dimensional images at strain, and the errors in image acquisition (221/483, 45.76%) and measurement (262/483, 54.24%) were the main reasons for nonqualification. For levator ani hiatus images, error in image acquisition (275/326, 84.36%) was the main reason for nonqualification. Reconstruction error was the most common reason for nonqualification for levator ani muscle (133/157, 84.71%) and anal sphincter images (133/268, 49.63%). Conclusions This multicenter study assessed the quality of TPUS in tertiary medical centers in China and identified the common reasons for nonqualification in each part. These findings can aid in forming the basis for quality control management and training for TPUS.
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Affiliation(s)
- Man Zhang
- Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jiawei Wu
- Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xin Lin
- Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Liang Mu
- Department of Ultrasound, Shaanxi Provincial People’s Hospital, Xi’an, China
| | - Guifeng Ma
- Department of Ultrasound, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Zhikun Zhang
- Department of Ultrasound, Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China
| | - Jing Shi
- Department of Ultrasound, Guiyang Maternal and Child Health Care Hospital, Guiyang, China
| | - Shaozheng He
- Department of Ultrasound, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Yanan Ma
- Department of Ultrasound, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Ning Shang
- Department of Ultrasound, Guangdong Women and Children Hospital, Guangzhou, China
| | - Hongyan Wang
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Suzhen Ran
- Department of Ultrasound, Women and Children’s Hospital of Chongqing Medical University, Chongqing Health Center for Women and Children, Chongqing, China
| | - Xudong Wang
- Department of Ultrasound, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jiawei Tian
- Department of Ultrasound, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Enze Qu
- Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xinling Zhang
- Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Do JE, Tucker J, Parange A, Hoang VM, Juszczyk K, Murphy EMA. Are we using best practice to guide laxative use in post-partum patients with obstetric anal sphincter injuries - A retrospective review. Eur J Obstet Gynecol Reprod Biol 2023; 288:78-82. [PMID: 37453346 DOI: 10.1016/j.ejogrb.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/02/2023] [Accepted: 07/04/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE Obstetric anal sphincter injury (OASI) is the leading cause of anal incontinence (AI) in young women. Laxatives are recommended to enhance recovery, however there are no consistent guidelines to guide best practice on the type, frequency, and dose of laxative should be used. This study aimed to evaluate the current use of laxatives following repair of OASIs, and to determine any association with AI. Study design A retrospective cohort study of 356 women who sustained OASIs between January 2016 and June 2020, at a single tertiary centre in Adelaide. Data regarding the type, dose and frequency of laxatives prescribed was extracted from each patient. The degree of OASIs was determined by clinical examination and endoanal ultrasound, and AI was measured by the St Marks incontinence score. RESULTS Multiple combinations and classes of laxatives were prescribed including bulking agent (Metamucil and Fybogel), emollients (Coloxyl), and osmotic laxatives (lactulose and Movicol). Bulking agents were prescribed for 245 women (68.8%), which is contrary to the current recommendations based on two previous randomised controlled trials. AI reported by 51 (14.3%) women. There were no statistical differences between AI and laxative type, dose, or frequency. CONCLUSION Considerable variation existed in laxatives prescription. Bulking agents was not associated with higher rates of AI. Further research is required to improve post-partum care in women following repair of OASIs.
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Affiliation(s)
- Jee Eun Do
- Division of Surgical Specialties and Anaesthetics, Northern Adelaide Local Health Network, Lyell McEwin Hospital, Haydown Road, Elizabeth Vale, SA 5112, Australia.
| | - Julie Tucker
- Continence Nursing Service, Women and Children's Division, Northern Adelaide Local Health Network, Lyell McEwin Hospital, Haydown Road, Elizabeth Vale, SA 5112, Australia.
| | - Anupam Parange
- Head of Obstetrics and Gynaecology, Women and Children's Division, Northern Adelaide Local Health Network, Lyell McEwin Hospital, Haydown Road, Elizabeth Vale, SA 5112, Australia.
| | - Van Mt Hoang
- Division of Surgical Specialties and Anaesthetics, Northern Adelaide Local Health Network, Lyell McEwin Hospital, Haydown Road, Elizabeth Vale, SA 5112, Australia.
| | - Karolina Juszczyk
- Division of Surgical Specialties and Anaesthetics, Northern Adelaide Local Health Network, Lyell McEwin Hospital, Haydown Road, Elizabeth Vale, SA 5112, Australia.
| | - Elizabeth Mary Ann Murphy
- Division of Surgical Specialties and Anaesthetics, Northern Adelaide Local Health Network, Lyell McEwin Hospital, Haydown Road, Elizabeth Vale, SA 5112, Australia.
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Mohd Raihan FS, Kusuma J, Nasution AA. Neonatal head circumference as a risk factor for obstetric anal sphincter injuries: a systematic review and meta-analysis. Am J Obstet Gynecol MFM 2023; 5:101047. [PMID: 37277090 DOI: 10.1016/j.ajogmf.2023.101047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/26/2023] [Accepted: 05/31/2023] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Between 53% and 79% of women will sustain some degree of perineal laceration during vaginal delivery. Third- and fourth-degree perineal lacerations are known as obstetric anal sphincter injuries. Timely diagnosis and prompt treatment of obstetric anal sphincter injuries can help to prevent the development of severe consequences like fecal incontinence, urinary incontinence, and rectovaginal fistula. Neonatal head circumference is routinely measured postpartum but is often not mentioned as a risk factor for obstetric anal sphincter injuries in clinical guidelines. Thus far, no review article on the risk factors for obstetric anal sphincter injuries has discussed the role of neonatal head circumference. This study aimed to review and analyze the relationship between head circumference and the occurrence of obstetric anal sphincter injuries among previous studies to conclude whether head circumference should be recognized as an important risk factor. DATA SOURCES Through study screening on Google Scholar, PubMed, Scopus, and Science Direct for articles published between 2013 to 2023, followed by assessment of eligibility, this study ended up reviewing 25 studies, 17 of which were included in the meta-analysis. STUDY ELIGIBILITY CRITERIA Only studies that reported both the neonatal head circumference and the occurrence of obstetric anal sphincter injuries were included in this review. METHODS The included studies were appraised using the Dartmouth Library risk of bias assessment checklist. Qualitative synthesis was based on the study population, findings, adjusted confounding factors, and suggested causative links in each study. Quantitative synthesis was conducted using calculation and pooling of odds ratios and inverse variance using Review Manager 5.4.1. RESULTS A statistically significant association between head circumference and obstetric anal sphincter injuries was reported in 21 of 25 studies; 4 studies reported that head circumference was a true independent risk factor. A meta-analysis of the studies that reported neonatal head circumference as a dichotomous categorical variable with a cutoff point of 35±1 cm yielded statistically significant pooled results (odds ratio, 1.92; 95% confidence interval, 1.80-2.04). CONCLUSION The risk for obstetric anal sphincter injuries increased as the neonatal head circumference increased-this should be considered in decision-making during labor and postpartum management to attain the best outcome.
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Affiliation(s)
| | - Julianty Kusuma
- Department of Obstetrics and Gynecology, Dr M. Yunus Regional General Hospital, Bengkulu, Indonesia (Dr Kusuma); Department of Medical Doctor Profession Education, Faculty of Medicine and Health Sciences, Universitas Bengkulu, Bengkulu, Indonesia (Dr Kusuma)
| | - Ahmad Azmi Nasution
- Department of Anatomy, Faculty of Medicine and Health Sciences, Universitas Bengkulu, Bengkulu, Indonesia (Dr Nasution)..
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Young C, Bhattacharya S, Woolner A, Ingram A, Smith N, Raja EA, Black M. Maternal and perinatal outcomes of prolonged second stage of labour: a historical cohort study of over 51,000 women. BMC Pregnancy Childbirth 2023; 23:467. [PMID: 37349683 DOI: 10.1186/s12884-023-05733-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 05/24/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Prolonged second stage of labour has been associated with adverse maternal and perinatal outcomes. The maximum length of the second stage from full dilatation to birth of the baby remains controversial. Our aim was to determine whether extending second stage of labour was associated with adverse maternal and perinatal outcomes. METHODS A retrospective cohort study was conducted using routinely collected hospital data from 51592 births in Aberdeen Maternity Hospital between 2000 and 2016. The hospital followed the local guidance of allowing second stage of labour to extend by an hour compared to national guidelines since 2008 (nulliparous and parous). The increasing duration of second stage of labour was the exposure. Baseline characteristics, maternal and perinatal outcomes were compared between women who had a second stage labour of (a) ≤ 3 h and (b) > 3 h duration for nulliparous women; and (a) ≤ 2 h or (b) > 2 h for parous women. An additional model was run that treated the duration of second stage of labour as a continuous variable (measured in hours). All the adjusted models accounted for: age, BMI, smoking status, deprivation category, induced birth, epidural, oxytocin, gestational age, baby birthweight, mode of birth and parity (only for the final model). RESULTS Each hourly increase in the second stage of labour was associated with an increased risk of obstetric anal sphincter injury (aOR 1.21 95% CI 1.16,1.25), having an episiotomy (aOR 1.48 95% CI 1.45, 1.52) and postpartum haemorrhage (aOR 1.27 95% CI 1.25, 1.30). The rates of caesarean and forceps delivery also increased when second stage duration increased (aOR 2.60 95% CI 2.50, 2.70, and aOR 2.44 95% CI 2.38, 2.51, respectively.) Overall adverse perinatal outcomes were not found to change significantly with duration of second stage on multivariate analysis. CONCLUSIONS As the duration of second stage of labour increased each hour, the risk of obstetric anal sphincter injuries, episiotomies and PPH increases significantly. Women were over 2 times more likely to have a forceps or caesarean birth. The association between adverse perinatal outcomes and the duration of second stage of labour was less convincing in this study.
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Affiliation(s)
- Catriona Young
- Aberdeen Centre for Women's Health Research (ACWHR), Foresterhill, University of Aberdeen, Aberdeen, AB25 2ZD, UK.
| | - Sohinee Bhattacharya
- Aberdeen Centre for Women's Health Research (ACWHR), Foresterhill, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - Andrea Woolner
- Aberdeen Centre for Women's Health Research (ACWHR), Foresterhill, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - Amy Ingram
- Raigmore Hospital, NHS Highland, Inverness, IV2 3UJ, UK
| | - Nicole Smith
- Golden Jubilee Hospital, NHS Greater Glasgow and Clyde, Clydebank, G81 4DY, UK
| | | | - Mairead Black
- Aberdeen Centre for Women's Health Research (ACWHR), Foresterhill, University of Aberdeen, Aberdeen, AB25 2ZD, UK
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Jiménez-Arbeláez AL, Giraldo-Giron P, Arias-Zapata C, Campo-Campo MN, Echavarria-Restrepo LG, Cuesta-Castro DP. Incidencia, complicaciones inmediatas y tempranas de desgarros perineales graves durante el parto en una institución de referencia de atención obstétrica en Medellín, Colombia. IATREIA 2023. [DOI: 10.17533/udea.iatreia.210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
Abstract
Introducción: los desgarros perineales severos (DPS) son complicaciones obstétricas que se presentan durante la atención del parto. Pueden desencadenar fístulas rectales e incontinencia fecal y urinaria, morbilidad a mediano y largo plazo que requiere un diagnóstico, manejo y seguimiento adecuado. Objetivo: determinar la incidencia de los DPS y las complicaciones relacionadas inmediatas −primeras 48 horas− y tempranas −primeros tres meses− posteriores a la atención del parto.Metodología: se hizo un estudio de cohorte descriptiva de pacientes con DPS durante la atención del parto en un centro de referencia de atención obstétrica en Medellín, Colombia, entre enero del 2015 y diciembre del 2017. Se revisaron las historias clínicas y se registraron los datos clínicos y las complicaciones inmediatas y tempranas en las que asistieron a cita de control de piso pélvico. Se presentan medidas descriptivas de resumen.Resultados: se atendieron 14.247 partos vaginales. La incidencia de DPS fue del 1,6 % (233/14.247), 1,3 % (184/14.267) de grado III y 0,3 % (49/14.247) de grado IV. El 66,5 % (155/233) tuvo parto vértice instrumentado, 81,9 % (191/233) episiotomía; la mediana del periodo expulsivo fue de 19 minutos (RIQ 12-35), y el 3 % (7/233) presentó distocia de hombros. Las complicaciones inmediatas en las pacientes con DPS fueron: 0,85 % (2/233) dehiscencia de sutura e infección de la herida, 0,85 % (2/233) solo dehiscencia y 0,42 % (1/233) solo infección de la herida. El 18,4 % (43/233) asistieron al control uroginecológico al tercer mes. Entre ellas, el 38,2 % (13/43) tuvo al menos una complicación, principalmente incontinencia fecal y de flatos, 16,3 % (7/43) y 13,9 % (6/43) respectivamente. Conclusiones: la incidencia de DPS y de complicaciones del posparto inmediato en la institución fueron poco frecuentes. Se deben mejorar las estrategias de seguimiento posparto mediante protocolos institucionales, con el fin de identificar y brindar un manejo oportuno de las complicaciones a mediano plazo.
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Akıncı O, Keklikkıran ZZ, Tosun Y. Comparison of the outcomes of overlapping and direct apposition sphincteroplasty techniques in anal sphincter repair. Turk J Surg 2022; 38:134-139. [PMID: 36483173 PMCID: PMC9714655 DOI: 10.47717/turkjsurg.2022.5648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 05/17/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Sphincteroplasty is of great importance in the repair of anal sphincter damage. In the present study, we compared the results of overlapping sphincteroplasty and direct apposition techniques used in anal sphincter repair. MATERIAL AND METHODS Between 2011 and 2021, 36 patients underwent sphincteroplasty for anal sphincter injury and were analysed retrospectively. Sex, age, etiologic factors, repair technique, degree of laceration, postoperative complications, length of hospital stay, time between injury and repair, follow-up time and postoperative Cleveland Clinic Incontinence Score (CCIS) were recorded for analysis, and the two techniques were compared statistically using SPSS statistics, Version 17.0. RESULTS Of the sample, 31 were females and five were males, with a mean age of 31.50 ± 6.7 years. The etiologic factors were obstetric trauma in 25 patients, perianal interventions in seven patients and other traumas in four patients. The overlapping technique was applied to 14 patients and the direct apposition technique was applied to 22 patients. Mean postoperative CCIS of all cases was 5.53 ± 2.59, and was significantly lower in those who underwent overlapping sphincteroplasty technique than those who underwent apposition repair (p= 0.006). It was observed that postoperative CCIS decreased as the time between sphincter injury and repair decreased (p <0.001; r= 0.625). CONCLUSION It is vital to repair anal sphincter damage as early as possible. The overlapping sphincteroplasty and direct apposition methods can both be considered safe for anal sphincter repair although in terms of faecal incontinence, the outcomes of overlapping sphincteroplasty are better than those of the direct apposition technique.
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Affiliation(s)
- Ozan Akıncı
- Clinic of General Surgery, Kartal Dr. Lütfi Kırdar City Hospital, İstanbul, Türkiye
| | | | - Yasin Tosun
- Clinic of General Surgery, Kartal Dr. Lütfi Kırdar City Hospital, İstanbul, Türkiye
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