Reproducibility of External Anal Sphincter Elastic Properties Assessment Using Elastography During Pregnancy

Study Overview
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Brief Summary
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The risk prediction of obstetric anal sphincter injury couyl be optimized by considering pregnant women's anal sphincter intrinsic viscoelastic properties. Shear wave elastography is a new technology that allowed an in vivo assessment of viscoelastic properties of tissues such as muscles. The main endpoint of this study is to assess the intra-observer and the inter-observer reproducibility of a the external anal sphincter assessment using shear wave elastography in term pregnant women.

Detailed Description
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Investigations Assessment of the external anal sphincter viscoelastic properties using shear wave elastography technology using a transperineal approach in term pregnant women in two visits (the 1st one with only one observer and the second one with two observers) Follow up Prospective study including nulliparous term pregnant women with 2 visits planned, spaced at least by 12 hours and, for the most, 7 days. Primary outcome: The mean value of shear modulus measures in the external anal sphincter for the three considered conditions (rest, Valsalva maneuver and contraction) at each visit and for each observer with a calculation of Intraclass Correlation Coefficient and Variation Coefficient. Secondary outcomes: The secondary outcomes will be the percentage of completed procedure (ability to see the external sphincter and to obtain a measure of the shear modulus), the existence of a perineal tear according the RCOG-OMS classification and the answer to an acceptability question. Study design: Prospective monocentric study including nulliparous term pregnant women with two visits spaced of at least 12 hours and, for the most, 7 days. Interventions: Assessment of the external anal sphincter viscoelastic properties using shear wave elastography technology Women in lithotomy position with an empty bladder The linear probe is applied on transversal plane on the perineal with a transperineal approach The external anal sphincter will be identified in 2D ultrasound using a SL 18-5 linear probe Viscoelastic properties of the muscle will be assessed by measuring the shear modulus at rest, Valsalva maneuver and contraction Exactly the same investigations will be performed for the two visits planned in the protocol. In the first visit, it will be one single observer and for the second it will be 2 observers. Data about the mode of delivery and the occurrence of OASI will be collected into women's medical file Number of subjects: 40 volunteers pregnant women are planned for this research Statistical analysis: The number of successful procedures will be reported as effectives and percentages. Reproducibility will be reported by calculating the coefficient of variation and the intraclass correlation coefficient. The level of significance will be considered for p<0.05 Conditions : Obstetric anal sphincter injury Keywords: OASI; childbirth; perineal traumatism; delivery; biomechanics; shear wave elastography

Official Title
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Reproducibility of External Anal Sphincter Elastic Properties Assessment Using Elastography During Pregnancy

Conditions
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Obstetric Anal Sphincter Injury

Intervention / Treatment
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* Diagnostic Test: Shear wave elastography assessment of the external anal sphincter


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: pregnant women aged of 18 years or more 37 weeks or more of pregnancy without any previous delivery (vaginal or cesarean delivery) body mass index < 35Kg.m-2 without history of Crohn's disease without history of peri anal surgery without any proctologic disease without any muscular chronic disease having a normal pregnancy without any untreated psychiatric disorders without any judicial protection affiliated to a health insurance Exclusion Criteria: pregnant women younger than 18 years old obstetric term inferior than 37 weeks history of vaginal and/or cesarean delivery body mass index of 35Kg.m-2 or more history of Crohn's disease history of peri anal surgery proctologic disease muscular chronic disease pathological pregnancy (intrauterine growth restriction, pre eclampsia etc..) untreated psychiatric disorders women under judicial protection women without affiliated to a health insurance

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Intervention/Treatment |
| --- |
|Diagnostic Test: Shear wave elastography assessment of the external anal sphincter|Assessment of the external anal sphincter viscoelastic properties using shear wave elastography technology Women in lithotomy position with an empty bladder The linear probe is applied on transversal plane on the perineal with a transperineal approach The external anal sphincter will be identified in 2D ultrasound using a SL 18-5 linear probe Viscoelastic properties of the muscle will be assessed by measuring the shear modulus at rest, Valsalva maneuver and contraction Exactly the same investigations will be performed for the two visits planned in the protocol. In the first visit, it will be one single observer and for the second it will be 2 observers. Data about the mode of delivery and the occurrence of OASI will be collected into women's medical fil|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| value of shear modulus measures in the external anal sphincter for each visit with the calculation of the ICC | The mean value of shear modulus measures in the external anal sphincter for the three considered conditions (rest, Valsalva maneuver and contraction) at each visit and for each observer with a calculation of Intraclass Correlation Coefficient | up to seven days | 
| value of shear modulus measures in the external anal sphincter for each visit with the calculation of the coefficent of variation | The mean value of shear modulus measures in the external anal sphincter for the three considered conditions (rest, Valsalva maneuver and contraction) at each visit and for each observer with a calculation of Variation Coefficient | up to seven days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Perineal tears at childbirth | the existence of a perineal tear according the RCOG-OMS classification | up to 4 weeks | 
| Feasibility of the assessment of the external anal sphincter: percentage of completed procedure | percentage of completed procedure (ability to identify the extarnal anal sphincter and to perform a shear wave elastography assessment) | up to seven days | 
| Acceptability of the procedure: question with a scale | answer to the acceptability question with a scale from 0 to ten | up to seven days |