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KMID : 0877920090110030108
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Korean Journal of Ultrasound in Obstetrics and Gynocology
2009 Volume.11 No. 3 p.108 ~ p.114
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Postpartum Transvaginal Ultrasound Evaluation of Anal Sphincter Injury During Vaginal Delivery with Episiotomy in Primiparous Women
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Choi Eun-Joo
Seo Yong-Soo
Roh Cheong-Rae
Choi Suk-Joo
Kim Dae-Woon
Shin Jung-Hwan
Hong Seo-Yoo
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Abstract
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Objective: To examine the incidence and risk factors of anal sphincter injury during vaginal delivery with episiotomy in primiparous women using transvaginal ultrasound.
Methods: We performed a case-control study of primiparous women who delivered vaginally from March 2008 to June 2008. Women who had fecal incontinence symptoms, hemorrhoids, a history of perineal injury or anal region operation and who delivered at preterm were excluded. The study recruited 71 patients. Transvaginal ultrasound was performed within 72 hours after delivery to examine anal sphincter integrity. Subjects were categorized into two groups: Group 1, with anal sphincter injury; Group 2, without anal sphincter injury.
Results: External anal sphincter injury was discovered in 12.7% (9/71) of patients who underwent transvaginal ultrasound. Sixty-seven percent (6/9) of anal sphincter injuries diagnosed by ultrasound examinations were undetectable at the time of delivery. The mean external and internal sphincter thicknesses were 17.0±4.7 (mean±SD)mm and 22.1±6.1 mm, respectively, and the values were not different between the two groups. There was no difference in other factors between the two groups. The type of episiotomy and the use of a vacuum resulted in no differences between the two groups.
Conclusion: The Asian race and episiotomy both are risk factors of anal sphincter injury during delivery. However, the frequency of severe perineal laceration in primiparae who went through routine episiotomy delivery in Korean hospitals was 4.2% (3/71), and the injury rate of the anal sphincter was 12.7% (9/71), according to ultrasound examination. These results were not as high as in studies reported from regions other than Asia. Also, 67% (6/9) of anal sphincter injuries discovered in ultrasound examinations were not known at the time of delivery.
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KEYWORD
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Anal sphincter, Ultrasound, Episiotomy, Primiparity
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