Abstract：
Obstetric anal sphincter injuries are frequently missed and carry a significant risk for the development of anal incontinence. Immediate postpartum endoanal ultrasound increases identification of these injuries but is rarely employed. We hypothesize that endovaginal ultrasound could be a feasible and easily available alternative sonographic tool to improve early diagnosis of anal sphincter tears.
We conducted a prospective experimental study including 160 primiparous women. Shortly after vaginal delivery, patients underwent clinical and sonographic perineal examinations. We analyzed the feasibility of anal sphincter assessment by endovaginal ultrasound and its potential contribution in the early diagnosis of anal sphincter injuries.
Sonographic assessment of the anal sphincter was analyzable for 136 patients (85.0%). Causes of non-analyzability included air artifacts (6.9%), lack of distinction between the external anal sphincter and surrounding tissues (9.4%) and distortion artifacts (9.4%). Patients in the non-analyzable ultrasound subgroup were less likely to have delivered in a dorsal lithotomy position (62.5% vs. 85.3 %) and more likely to have had an episiotomy (33.3% vs. 14.0%), and their risk of sphincter injury was more frequently classified as \"improbable\" on clinical examination (91.7% vs. 61.0%). Ultrasounds were analyzable for 96.4% of patients clinically reported as having \"possible\" or \"certain\" sphincter injuries. The incidence of anal sphincter injury was 16.9% for clinical observation and 20.0% with associated sonographic examination.
Endovaginal ultrasound could be used as a complementary tool in assessment of the anal sphincter in high-risk patients. Its feasibility and easy availability make this technique a promising tool for improving the management of anal sphincter tears.
We conducted a prospective experimental study including 160 primiparous women. Shortly after vaginal delivery, patients underwent clinical and sonographic perineal examinations. We analyzed the feasibility of anal sphincter assessment by endovaginal ultrasound and its potential contribution in the early diagnosis of anal sphincter injuries.
Sonographic assessment of the anal sphincter was analyzable for 136 patients (85.0%). Causes of non-analyzability included air artifacts (6.9%), lack of distinction between the external anal sphincter and surrounding tissues (9.4%) and distortion artifacts (9.4%). Patients in the non-analyzable ultrasound subgroup were less likely to have delivered in a dorsal lithotomy position (62.5% vs. 85.3 %) and more likely to have had an episiotomy (33.3% vs. 14.0%), and their risk of sphincter injury was more frequently classified as \"improbable\" on clinical examination (91.7% vs. 61.0%). Ultrasounds were analyzable for 96.4% of patients clinically reported as having \"possible\" or \"certain\" sphincter injuries. The incidence of anal sphincter injury was 16.9% for clinical observation and 20.0% with associated sonographic examination.
Endovaginal ultrasound could be used as a complementary tool in assessment of the anal sphincter in high-risk patients. Its feasibility and easy availability make this technique a promising tool for improving the management of anal sphincter tears.
摘要：
产科肛门括约肌损伤经常被遗漏，并且具有发生肛门失禁的重大风险。立即产后肛门内超声可增加对这些损伤的识别，但很少使用。我们假设阴道超声可能是一种可行且易于使用的替代超声检查工具，以改善肛门括约肌撕裂的早期诊断。
我们进行了一项前瞻性实验研究，包括160名初产妇。阴道分娩后不久，患者接受临床和超声检查会阴。我们分析了通过阴道内超声评估肛门括约肌的可行性及其在肛门括约肌损伤早期诊断中的潜在贡献。
对136例患者（85.0%）的肛门括约肌超声检查结果进行了分析。不可分析性的原因包括空气伪影(6.9%)，肛门外括约肌和周围组织之间缺乏区别（9.4％）和变形伪影（9.4％）。不可分析超声亚组的患者不太可能在背侧截石术位置分娩(62.5%vs.85.3％），并且更有可能进行过会阴切开术（33.3％与14.0%），在临床检查中，他们的括约肌损伤风险更频繁地被归类为“不可能”(91.7%vs.61.0%）。超声可分析96.4％的临床报告为“可能”或“某些”括约肌损伤的患者。临床观察肛门括约肌损伤的发生率为16.9%，超声检查为20.0%。
阴道超声可作为评估高危患者肛门括约肌的补充工具。它的可行性和易用性使该技术成为改善肛门括约肌撕裂管理的有前途的工具。
我们进行了一项前瞻性实验研究，包括160名初产妇。阴道分娩后不久，患者接受临床和超声检查会阴。我们分析了通过阴道内超声评估肛门括约肌的可行性及其在肛门括约肌损伤早期诊断中的潜在贡献。
对136例患者（85.0%）的肛门括约肌超声检查结果进行了分析。不可分析性的原因包括空气伪影(6.9%)，肛门外括约肌和周围组织之间缺乏区别（9.4％）和变形伪影（9.4％）。不可分析超声亚组的患者不太可能在背侧截石术位置分娩(62.5%vs.85.3％），并且更有可能进行过会阴切开术（33.3％与14.0%），在临床检查中，他们的括约肌损伤风险更频繁地被归类为“不可能”(91.7%vs.61.0%）。超声可分析96.4％的临床报告为“可能”或“某些”括约肌损伤的患者。临床观察肛门括约肌损伤的发生率为16.9%，超声检查为20.0%。
阴道超声可作为评估高危患者肛门括约肌的补充工具。它的可行性和易用性使该技术成为改善肛门括约肌撕裂管理的有前途的工具。
