INTRODUCTION AND HYPOTHESIS: To study the correlation between transperineal ultrasound (TPUS) findings immediately after birth and postpartum anal incontinence (AI) and constipation. METHODS: This is a prospective cohort study in pregnant patients who delivered vaginally at term. Participants filled in questionnaires, including the St. Mark's Incontinence Score and the Patient Assessment of Constipation Symptoms, at inclusion and at 6-weeks postpartum follow-up. TPUS acquisitions were performed immediately after birth to detect anal sphincter and levator defects, the dimensions of the genital hiatus as well as the dimensions of rectovaginal septum defects. We report on the prevalence and severity of AI and constipation at the postpartum follow-up and ran regression models to quantify the association between the former and TPUS findings immediately after birth. We calculated that a minimum of 156 patients were required to detect potential predictors for AI (power = 80%; alpha = 0.05; f2 = 0.15). RESULTS: Of 182 consecutive participants, 109 (60%) reported AI and 78 (43%) constipation. There were 37 (20.3%) women with a levator avulsion, 83 (46%) with an external anal sphincter defect in one or more TUI-sections and 29 (16%) with a rectovaginal septum defect. On univariate regression, sphincter defects were associated with AI [OR = 1.94(1.28-2.94)]. On multivariate regression, levator avulsion was the only independent sonographic predictor of AI [aOR = 2.57(1.03-7.44)], whereas sphincter defects, dimensions of the genital hiatus or rectovaginal defects were not correlated with AI. We identified no factors associated with constipation. CONCLUSIONS: The presence of levator avulsion immediately after vaginal delivery predicts postpartum AI. Ultrasound appearance of the anal sphincter, genital hiatus and rectovaginal septum was not informative.

• Klíčová slova
• Anal incontinence, Constipation, Levator avulsion, OASI, Obstetric injury, Pelvic floor ultrasound,
• 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.

• Klíčová slova
• Anal incontinence, Constipation, Gestation, Pelvic organ prolapse, Transperineal ultrasound, Urinary incontinence,
• MeSH
• anální kanál diagnostické zobrazování   MeSH
• dospělí MeSH
• inkontinence moči diagnostické zobrazování   MeSH
• komplikace těhotenství * diagnostické zobrazování   MeSH
• lidé MeSH
• onemocnění dna pánevního * diagnostické zobrazování   MeSH
• pánevní dno * diagnostické zobrazování   patofyziologie   MeSH
• prospektivní studie MeSH
• průzkumy a dotazníky MeSH
• těhotenství MeSH
• ultrasonografie MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH