Obstetric Trauma, Perineal Tear
Conditions
Keywords
perineal tear, bidigital palpation, perineal ultrasound, post partum diagnostics
Brief summary
Anovaginal distance measured by palpation and perineal ultrasound are similar.
Detailed description
Background: Objective diagnostic methods for obstetric anal sphincter rupture, (OASR) such as endoanalt ultrasound (EAUS), show missed ruptures that can lead to anal incontinence. To perform EAUS after all deliveries at all hours, although it may lead to diagnostic improvement is not feasible in most delivery wards. Another objective method for screening women after delivery to identify OASR would be of value. Bidigital palpation of the perineum is often suggested without specifying what results are relevant. AIM: The aim of this study was to establish if the palpated anovaginal distance after delivery could be confirmed by perineal ultrasound and correlated to the extent of the perineal tear. MATERIALS AND METHODS: A structured educational programme for midwives (palpation) and doctors (perineal ultrasound) was accomplished. Midwives were instructed to record the palpated anovaginal distance in primiparae with spontaneous vaginal delivery and no episiotomy. If the AVD was found to be shorter than 2 cm, she recorded a primary diagnosis of probable grade 2, suspected grade 3 or probable grade 3 and called the doctor. The AVD was then measured by perineal ultrasound by a doctor aware of a laceration but not it´s extent, which was then established by clinical exam and perineal ultrasound.
Interventions
DIAGNOSTIC_TESTBidigital palpation
palpation of the anovaginal distance with two fingers
DIAGNOSTIC_TESTPerineal ultrasound
ultrasound measurement of the anovaginal distance
Sponsors
Ostergotland County Council, Sweden
Study design
Observational model
CASE_ONLY
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
FEMALE
Healthy volunteers
No
Inclusion criteria
women who just had their firstborn child through vaginal delivery at the delivery ward at the University Hospital in Linköping, Sweden from October 2014 to January 2016. \-
Exclusion criteria
inability to understand swedish \-
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Correlation between palpated and ultrasound- measured anovaginal distance | immediate | Does palpation give a reliable result? |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Anal Sphincter rupture incidence | immediate | How common is anal sphincter rupture |
Outcome results
None listed