To evaluate the clinical performance and safety of the ONIRY system for obstetric anal sphincter injuries (OASI) detection versus three-dimensional endoanal ultrasound (EAUS). A prospective, comparative, multicentre, international study. Poland, Czechia, Slovakia, and Spain. 152 women between the first moments up to 8 weeks after vaginal delivery. Participants underwent EAUS and were allocated to groups based on OASIS classification: A (no perineal tear), B (1st or 2nd degree tear), or C (3rd or 4th degree, anal sphincters affected). Electric impedance was measured in the anal canal using the ONIRY system. The primary endpoint was the diagnostic outcome of impedance spectroscopy versus EAUS. Adverse events were collected. Part II involved in silico modelling and 10-time 10-fold cross-validation for automated analysis. Accuracy, sensitivity, and specificity. 30 women were allocated to group A, 61 to group B, and 61 to group C. The diagnostic outcome was determined for 147 participants. The accuracy, sensitivity, and specificity of the ML-assisted impedance spectroscopy were 87.0 ± 0.5%, 90.6 ± 2.0%, and 84.6 ± 1.9%, respectively, compared with EAUS. After data cleaning, the performance metrics of the proposed final ML model for ONIRY were: 90.0 ± 0.4%, 90.0 ± 1.2%, and 90.0 ± 0.7%, respectively. No adverse device effects or deficiencies were observed. By enabling early identification of sphincter injuries, ML-assisted impedance spectroscopy facilitates timely diagnosis and intervention, potentially reducing long-term complications such as faecal incontinence. Its rapid, bedside application in obstetric settings supports immediate postpartum care, complementing digital rectal examination and optimizing clinical decision-making.
- MeSH
- anální kanál * zranění diagnostické zobrazování MeSH
- dospělí MeSH
- impedanční spektroskopie * metody MeSH
- komplikace porodu diagnóza diagnostické zobrazování MeSH
- lidé MeSH
- prospektivní studie MeSH
- strojové učení * MeSH
- těhotenství MeSH
- vedení porodu * škodlivé účinky MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- srovnávací studie MeSH
OBJECTIVE: To assess the prevalence of pelvic floor and anal sphincter trauma in women after assisted vaginal delivery. METHODS: Retrospective study on 201 primiparous women after assisted vaginal delivery, control group 43 women after normal vaginal delivery. 4D translabial ultrasound examination of the levator ani and the anal sphincter was performed according to standard methodology at least 3 months postpartum. Ultrasound classification of trauma was performed by two independent evaluators blinded to clinical data. A third evaluator was asked to confirm findings in case of discrepancy. RESULTS: The LAM avulsion rate for normal delivery was 20.9%, for forceps 60%, for vacuum extraction 21.7% Odds ratio for forceps vs. NVD was 4.32 (1.69, 11.01), for vacuum vs. NVD 0.98 (0.409, 2.327). Ultrasound OASI rate was 33.3% for Forceps and 30.50% for Vacuum. This equated to an OR of 1.78 (0.85 - 3.10) for Forceps and 1.62 (0.85-3.10) for Vacuum relative to NVD. CONCLUSIONS: Our data confirm forceps as the major risk factor for levator avulsion. Forceps also implies a non-significantly higher risk of OASI compared to NVD.
- MeSH
- anální kanál * zranění diagnostické zobrazování MeSH
- dospělí MeSH
- extrakce porodnická škodlivé účinky MeSH
- lidé MeSH
- mladý dospělý MeSH
- pánevní dno * diagnostické zobrazování zranění MeSH
- porodnické kleště škodlivé účinky MeSH
- retrospektivní studie MeSH
- těhotenství MeSH
- ultrasonografie * metody MeSH
- vakuová extrakce porodnická * škodlivé účinky MeSH
- vedení porodu škodlivé účinky metody MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladý dospělý MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
INTRODUCTION AND HYPOTHESIS: Pregnancy and childbirth predispose to pelvic floor dysfunction (PFD), coinciding with functional and anatomical changes in the pelvic floor. To some extent, these can be assessed by transperineal ultrasound (TPUS), yet the correlation between ultrasound findings and symptoms has not been well elucidated. We hypothesised that pregnant women with PFD would show different findings at TPUS. METHODS: This is a planned secondary analysis of a prospective cohort study. Pregnant women were asked to fill out standardised questionnaires on PFD and undergo TPUS at 12-14 weeks and 28-32 weeks of gestation. We compared bladder neck descent, urethral rotation, retrovesical angle, pelvic organ descent, genital hiatus dimensions and the presence of anal sphincter defects between women with and those without PFD using t test and Fisher's exact test. Linear mixed-effects models were used to assess the correlation between TPUS findings and PFD severity. As this is a secondary subgroup analysis of participants who underwent TPUS, no sample size was determined upfront. RESULTS: At Valsalva, women with urinary incontinence had more pronounced bladder neck descent (p = 0.02) and urethral rotation (p < 0.01), as well as wider retrovesical angles (p = 0.04) and larger genital hiatus areas (p < 0.01). After controlling for age, BMI and parity, the retrovesical angle was the only persistent predictor of urinary incontinence. No correlation was observed between any TPUS marker and symptoms of either prolapse or anorectal dysfunction. CONCLUSIONS: In pregnant women, symptoms of urinary incontinence, but not of prolapse and anorectal dysfunction, are associated with differences in pelvic floor anatomy at TPUS.
- MeSH
- anální kanál diagnostické zobrazování MeSH
- dospělí MeSH
- inkontinence moči diagnostické zobrazování etiologie patofyziologie MeSH
- komplikace těhotenství * diagnostické zobrazování patofyziologie MeSH
- lidé MeSH
- onemocnění dna pánevního * diagnostické zobrazování patofyziologie etiologie MeSH
- pánevní dno * diagnostické zobrazování patofyziologie MeSH
- prospektivní studie MeSH
- těhotenství MeSH
- ultrasonografie MeSH
- uretra diagnostické zobrazování patofyziologie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
OBJECTIVES: To assess the feasibility of acquiring adequate transperineal ultrasound (TPUS) volumes of the anal sphincter (AS) immediately after vaginal birth, the reproducibility of its measurements, and detecting defects therein. METHODS: Secondary analysis of TPUS volumes of the AS, acquired immediately after vaginal birth with a transversely oriented convex probe. Two independent experts ranked off-line image quality as "inadequate," "adequate," or "ideal" using the Point-of-Care Ultrasound Image Quality scale. On "adequate" and "ideal" quality volumes, the length of the external AS at 6 and 12 o'clock, and the volume of the external and internal AS were measured. Additionally, volumes were screened for AS defects on tomographic ultrasound imaging. Subsequently, we rated the intra- and interrater agreement on those findings. RESULTS: Of 183 volumes, 162 were considered "adequate" or of "ideal" quality (88.5%). Reasons for "inadequacy" were shadow artifacts (16/21), poor resolution (3/21), incomplete acquisition (1/21), or aberrant AS morphology (1/21). The intrarater reliability of two-dimensional (2D) and three-dimensional (3D) measurements was excellent, whereas interrater reliability was fair to good for 2D measurements and good for 3D measurements. In those tomographic ultrasound imaging (TUI) sequences including AS defects, the intra- and interrater reliability of the defect measurement were excellent [intraclass correlation coefficient (ICC) = 0.92 (0.80-0.94)] and moderate [ICC = 0.72 (0.63-0.79)]. In this cohort, there were only few (4/48; 8.3%) AS defects. However, grading them was poorly reproducible between experts. CONCLUSION: TPUS of the AS immediately after vaginal birth yields adequate image quality and allows for reproducible measurements. In the few patients with AS defects, there was good agreement on the presence, but it was poor for the extent of defects.
- MeSH
- anální kanál * diagnostické zobrazování MeSH
- dospělí MeSH
- lidé MeSH
- perineum diagnostické zobrazování MeSH
- reprodukovatelnost výsledků MeSH
- studie proveditelnosti * MeSH
- těhotenství MeSH
- ultrasonografie * metody MeSH
- zobrazování trojrozměrné * metody MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
OBJECTIVES: Obstetrical anal sphincter injuries (OASIS) are complications of vaginal delivery. Unrepaired anal sphincter after delivery increases the risk of anal incontinence. The aim of our study is to search for residual defect after OASI repair by 4D introital ultrasound (US). We hypothesised that imaging prior to hospital discharge would show the same number of defects as assessment at 3 months. STUDY DESIGN: This is a retrospective analysis of 138 patients with immediate repair after OASIS. Since 2009, we have been routinely inviting all our patients with OASIS to the perineal clinic for postoperative follow-up. We scheduled the first visit before discharge from hospital and followed up with a second visit after three months. During both visits, patients underwent transperineal 4D ultrasound examination. We provided examination while at rest and during contraction; volumes were saved for further evaluation. RESULTS: Eighty-one patients (58.7%) completed both exams and were included in the analysis. Residual external anal sphincter defect was found in 17.3% at the first visit versus 13.6% at the second (delayed) visit. We were not able to assess the sphincter in 9.9% at early versus none in the delayed examination. In 9.9%, the residual defect was not confirmed by the second examination, and in 4.9% the residual defect was missed by the first examination. CONCLUSIONS: In conclusion, we have found that a 3 month scan yields a smaller number of defects than a scan before discharge.
- MeSH
- anální kanál diagnostické zobrazování zranění MeSH
- fekální inkontinence * diagnostické zobrazování etiologie MeSH
- komplikace porodu * MeSH
- lidé MeSH
- perineum zranění MeSH
- retrospektivní studie MeSH
- těhotenství MeSH
- ultrasonografie metody MeSH
- vedení porodu škodlivé účinky MeSH
- Check Tag
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- MeSH
- anální kanál * chirurgie diagnostické zobrazování patologie MeSH
- defekace MeSH
- diagnostické zobrazování metody MeSH
- epiziotomie metody MeSH
- lidé MeSH
- perineum chirurgie patologie MeSH
- peroperační komplikace chirurgie klasifikace MeSH
- porodnické chirurgické výkony * metody MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- přehledy MeSH
As a consequence of high-type anorectal malformations (ARMs) pathogenesis, the pelvic floor muscles remain severely underdeveloped or hypoplastic, the rectal pouch is located at the level or above the puborectalis sling, and the bowel terminates outside the sphincter muscle complex support. For children with high-type ARMs the ultimate objective of therapy is mainly to grow up having bowel continence function that is compatible with a good quality of life, and the final prognosis depends significantly on the grade of development of pelvic floor muscles and the successful entering of the anorectum fully within the support of the external anal sphincter due to intraoperative conservation of the puborectalis sling. Pelvic magnetic resonance imaging (MRI) has recently become the preferred imaging study for prediction of functional outcomes, since it can define the anatomy and evaluate the development of the sphincteric muscles before and after surgical correction. Based on recent literature and our clinical experience, we will discuss the relevance of pelvic floor muscles MRI to the clinical outcome of children with high type ARMs.
OBJECTIVE: The aim of this study was to explore the risk of levator ani muscle (LAM) avulsion and enlargement of the levator hiatus following vaginal birth after Cesarean section (VBAC) in comparison with vaginal delivery in primiparous women. METHODS: In this two-center observational case-control study, we identified all women who had a term VBAC for their second delivery at the Departments of Obstetrics and Gynecology at the Faculty of Medicine in Pilsen and the 1st Faculty of Medicine in Prague, Charles University, Czech Republic, between 2012 and 2016. Women with a repeat VBAC, preterm birth or stillbirth were excluded from the study. As a control group, we enrolled a cohort of primiparous women who delivered vaginally during the study period. To increase our control sample, we also invited all primiparous women who delivered vaginally in both participating units between May and June 2019 to participate. All participants were invited for a four-dimensional pelvic floor ultrasound scan to assess LAM trauma. LAM avulsion and the area of the levator hiatus were assessed offline from the stored pelvic floor volumes obtained at rest, during maximum contraction and during Valsalva maneuver. The laterality of the avulsion was also noted. The cohorts were then compared using the χ2 test and Wilcoxon's two-sample test according to the normality of the distribution. P < 0.05 was considered statistically significant. Multivariate regression analysis, controlling for age and body mass index (BMI), was also performed. RESULTS: A total of 356 women had a VBAC for their second delivery during the study period. Of these, 152 (42.7%) attended the ultrasound examination and full data were available for statistical analysis for 141 women. The control group comprised 113 primiparous women. A significant difference was observed between the VBAC group and the control group in age (32.7 vs 30.1 years; P < 0.05), BMI (28.4 vs 27.4 kg/m2 ; P < 0.05) and duration of the first and second stages of labor (293.1 vs 345.9 min; P < 0.05 and 27.6 vs 35.3 min; P < 0.05, respectively) at the time of the index birth. The LAM avulsion rate was significantly higher in the VBAC compared with the control group (32.6% vs 18.6%; P = 0.01). The difference between the groups was observed predominantly in the rate of unilateral avulsion and remained significant after controlling for age and BMI (adjusted odds ratio 2.061 (95% CI, 1.103-3.852)). There was no statistically significant difference in the area of the levator hiatus at rest (12.0 vs 12.6 cm2 ; P = 0.28) or on maximum Valsalva maneuver (18.6 vs 18.7 cm2 ; P = 0.55) between the VBAC and control groups. The incidence of levator hiatal ballooning was comparable between the groups (17.7% and 18.6%; P = 0.86). CONCLUSIONS: VBAC is associated with a significantly higher rate of LAM avulsion than is vaginal birth in nulliparous women. The difference was significant even after controlling for age and BMI. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
- MeSH
- anální kanál diagnostické zobrazování zranění MeSH
- dospělí MeSH
- komplikace porodu diagnostické zobrazování etiologie MeSH
- lidé MeSH
- poranění měkkých tkání diagnostické zobrazování etiologie MeSH
- studie případů a kontrol MeSH
- těhotenství MeSH
- ultrasonografie prenatální * MeSH
- vaginální porod po císařském řezu škodlivé účinky MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Cíl: Cílem této retrospektivní studie je srovnat vliv reziduálního defektu análního svěrače na kvalitu života pacientek po porodu komplikovaném rozsáhlým poraněním hráze. Soubor a metodika: Pacientky s diagnostikovaným rozsáhlým poraněním hráze zahrnující poranění análního svěrače jsou sledovány v rámci urogynekologické ambulance (průměrná doba follow-up 37 měsíců). Dva hodnotitelé zaslepení k nálezu klinického vyšetření provedli retrospektivní analýzu ultrazvukových volumů na přítomnost reziduálního defektu análního svěrače. Výsledky byly následně korelovány s výsledky St. Mark‘s Incontinence Score. Výsledky: Soubor se skládá ze 181 pacientek, u nichž bylo diagnostikováno v průběhu porodu poranění hráze III. či IV. stupně a které s odstupem 3 měsíců po porodu podstoupily ultrazvukové vyšetření. Kompletně vyplněné dotazníky odevzdalo 118 pacientek (65,2 % celého souboru). Z těchto pacientek byl v sedmi případech (5,9 %) přítomen reziduální defekt. Ve skupině s reziduálním defektem se fekální urgence (nemožnost odložit defekaci) vyskytovaly v 57,1 %. Ve skupině pacientek bez reziduálního defektu svěrače byly fekální urgence přítomny pouze ve 12,6 %. Tento rozdíl je signifikantní (< 0,001) s koeficientem kontingence 0,291. Závěr: Lze konstatovat, že přítomnost reziduálního defektu významně zvyšuje incidenci fekální urgence.
Aim: The aim of this retrospective study is to correlate the presence of residual anal sphincter defect with the quality of life of patients after vaginal delivery complicated with obstetrical anal sphincter injury. Study group and methods: Patients diagnosed with obstetrical anal sphincter injury are dispensed at our urogynecological unit, with a mean follow-up period of 37 months. Two investigators blinded to the results of clinical symptoms evaluated archived ultrasound volumes taken for the presence of residual anal sphincter defects that were later correlated with the St. Mark's Incontinence Score. Results: The group comprises of 181 patients diagnosed with an obstetrical anal sphincter injury who underwent ultrasound examination of anal sphincter at three post-partum months. The questionnaires were completed by 118 patients (65.2% of all patients). A residual sphincter defect was diagnosed in seven cases (5.9%). In the group with residual defects, fecal urgency (lack of ability to defer defecation) was present in 57.1%. In the group without residual anal sphincter defects, fecal urgency was present in 12.6%. This difference is significant (< 0.001) with the contingency coefficient 0.291. Conclusions: In conclusion, the presence of residual anal sphincter defect increases the probability of fecal urgency.
Cíl studie: Analýza vlastního souboru rodiček s poraněním hráze 3. a 4. stupně. Typ studie: Přehledový článek s analýzou vlastních dat. Pracoviště: GPK 1. LF UK a Nemocnice Na Bulovce, Praha. Úvod: Porodní poranění análního sfinkteru (obstetric anal sphincter injuries – OASIS) patří k obávaným komplikacím vaginálního porodu. Poranění je doprovázeno vysokou morbiditou rodičky. Mezi nejčastější obtíže patří bolestivost hráze, dyspareunie, úniky plynů a stolice. Poranění svěrače během porodu je hlavní příčinou anální inkontinence u žen. Výsledky: Během sledovaného období mezi lety 2015 až 2017 jsme na našem pracovišti odvedli celkem 6185 porodů. Císařským řezem bylo ukončeno 21 % porodů, vaginální extrakční operací 5,7 % a spontánně porodilo 73,3 % žen. Do našeho souboru bylo po vyloučení žen rodících císařským řezem zařazeno 4888 porodů. V našem souboru porodilo spontánně bez ohledu na poranění 92,8 % žen a u 7,2 % rodiček jsme provedli vaginální extrakční operaci. Poranění hráze 3. a 4. stupně se vyskytovalo u 1,7 % (83/4888) žen nezávisle na způsobu vaginálního ukončení. V 85,5 % se jednalo o nullipary. Ve skupině operačních porodů bylo riziko poranění análního svěrače vyšší. Poranění jsme detekovali u 5,4 % (19/352) takto ukončených těhotenství. Nejčastěji bylo diagnostikováno poranění hráze typu 3b, a to ve 47 %. Překvapením byl vysoký podíl mediolaterálních epiziotomií v celém souboru žen s diagnózou poranění sfinkteru. Jako nejčastější obtíže tři měsíce po porodu jsme zaznamenali občasný únik plynů a dyspareunii. Závěr: Porodní poranění análního svěrače je spjato s vysokou mateřskou morbiditou. Nejzávažnějším následkem je inkontinence stolice. Spolu s dalšími symptomy, jako je zhoršení kvality sexuálního života a perineální bolest, způsobuje psychosociální problémy. Pečlivé ošetření poranění a následná péče tato rizika snižují.
Objective: Analysis of women undergoing vaginal birth with 3rd or 4th degree perineal tears. Type of study: Review and analysis of the data from our department. Setting: Department of Gynecology and Obstetrics, 1st Medical Faculty of Charles University and Hospital Na Bulovce, Prague. Introduction: Obstetric anal sphincter injuries (OASIS) belong to dreaded complications after vaginal delivery. The injury is associated with significant maternal morbidity. The most common difficulties are perineal pain, dyspareunia, flatulence and anal incontinence. OASIS are main cause of anal incontinence in women. Main results: During monitored period 2015–2017 we performed 6185 childbirths in our ward. Cesarean section was performed at 21% of births, instrumental vaginal birth at 5,7% and 73,3% of women had a spontaneous vaginal birth. Our analysis included 4888 births. In our group 92,8% of women gave birth spontaneously regardless of injury and at 7,2% we performed an instrumental delivery. Perineal tears of 3rd and 4th degree were detected in 1,7% (83/4888) of vaginal births independent of vaginal ending. 85,5% were nulliparous women. In a group of instrumental deliveries the risk of OASI was higher. We have detected injury at 5,4% (19/352) of this type of delivery. The most detected perineal trauma in 47% was injury involving more than 50% of external anal sphincter thickness torn (3b). Surprising was a high incidence of mediolateral episiotomy in a group of women who sustained OASI. The most frequent symptoms three months after birth were flatus incontinence and dyspareunia. Conclusion: Obstetric anal sphincter injury is associated with significant maternal morbidity. The most serious consequence is an anal incontinence. With other symptoms as a dyspareunia and a perineal pain it leads to psychosocial problems. Thorough treatment reduces the risk of complications.
