Short Anovaginal Distance is Associated With Obstetric Anal Sphincter Rupture

Study Overview
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Brief Summary
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Anovaginal distance measured by palpation and perineal ultrasound are similar.

Detailed Description
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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.

Official Title
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Short Anovaginal Distance is Associated With Obstetric Anal Sphincter Rupture

Conditions
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Perineal Tear, Obstetric Trauma

Intervention / Treatment
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* Diagnostic Test: Bidigital palpation
* Diagnostic Test: Perineal ultrasound


Participation Criteria
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Eligibility Criteria
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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 -
Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Probable grad 2<br>Perineal laceration Probable grad 2 | Diagnostic Test: Bidigital palpation<br>* palpation of the anovaginal distance with two fingers<br>Diagnostic Test: Perineal ultrasound<br>* ultrasound measurement of the anovaginal distance<br>* Other names: transperineal ultrasound;|
| Suspected grade 3<br>Perineal laceration Suspected grade 3 | Diagnostic Test: Bidigital palpation<br>* palpation of the anovaginal distance with two fingers<br>Diagnostic Test: Perineal ultrasound<br>* ultrasound measurement of the anovaginal distance<br>* Other names: transperineal ultrasound;|
| Probable grad 3<br>Perineal laceration Probable grad 3 | Diagnostic Test: Bidigital palpation<br>* palpation of the anovaginal distance with two fingers<br>Diagnostic Test: Perineal ultrasound<br>* ultrasound measurement of the anovaginal distance<br>* Other names: transperineal ultrasound;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Correlation between palpated and ultrasound- measured anovaginal distance | Does palpation give a reliable result? | immediate | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Anal Sphincter rupture incidence | How common is anal sphincter rupture | immediate | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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perineal tear, bidigital palpation, perineal ultrasound, post partum diagnostics