Perineal Tear Clinical Trial
Official title:
Short Anovaginal Distance is Associated With Obstetric Anal Sphincter Rupture
Anovaginal distance measured by palpation and perineal ultrasound are similar.
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.
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