Short Anovaginal Distance is Associated With Obstetric Anal Sphincter Rupture

NCT ID: NCT03039582

Last Updated: 2017-02-13

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

151 participants

Study Classification

OBSERVATIONAL

Study Start Date

2014-09-01

Study Completion Date

2017-01-19

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.

Conditions

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Perineal Tear Obstetric Trauma

Study Design

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Observational Model Type

CASE_ONLY

Study Time Perspective

PROSPECTIVE

Study Groups

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Probable grad 2

Perineal laceration Probable grad 2

Bidigital palpation

Intervention Type DIAGNOSTIC_TEST

palpation of the anovaginal distance with two fingers

Perineal ultrasound

Intervention Type DIAGNOSTIC_TEST

ultrasound measurement of the anovaginal distance

Suspected grade 3

Perineal laceration Suspected grade 3

Bidigital palpation

Intervention Type DIAGNOSTIC_TEST

palpation of the anovaginal distance with two fingers

Perineal ultrasound

Intervention Type DIAGNOSTIC_TEST

ultrasound measurement of the anovaginal distance

Probable grad 3

Perineal laceration Probable grad 3

Bidigital palpation

Intervention Type DIAGNOSTIC_TEST

palpation of the anovaginal distance with two fingers

Perineal ultrasound

Intervention Type DIAGNOSTIC_TEST

ultrasound measurement of the anovaginal distance

Interventions

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Bidigital palpation

palpation of the anovaginal distance with two fingers

Intervention Type DIAGNOSTIC_TEST

Perineal ultrasound

ultrasound measurement of the anovaginal distance

Intervention Type DIAGNOSTIC_TEST

Other Intervention Names

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Vaginal ultrasound transperineal ultrasound

Eligibility Criteria

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Inclusion Criteria

\-

Exclusion Criteria

\-
Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Ostergotland County Council, Sweden

OTHER

Sponsor Role lead

Responsible Party

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Eva Uustal

Senior consultant

Responsibility Role PRINCIPAL_INVESTIGATOR

References

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Harvey MA, Pierce M, Alter JE, Chou Q, Diamond P, Epp A, Geoffrion R, Harvey MA, Larochelle A, Maslow K, Neustaedter G, Pascali D, Pierce M, Schulz J, Wilkie D, Sultan A, Thakar R; Society of Obstetricians and Gynaecologists of Canada. Obstetrical Anal Sphincter Injuries (OASIS): Prevention, Recognition, and Repair. J Obstet Gynaecol Can. 2015 Dec;37(12):1131-48. doi: 10.1016/s1701-2163(16)30081-0.

Reference Type BACKGROUND
PMID: 26637088 (View on PubMed)

Geller EJ, Robinson BL, Matthews CA, Celauro KP, Dunivan GC, Crane AK, Ivins AR, Woodham PC, Fielding JR. Perineal body length as a risk factor for ultrasound-diagnosed anal sphincter tear at first delivery. Int Urogynecol J. 2014 May;25(5):631-6. doi: 10.1007/s00192-013-2273-x. Epub 2013 Dec 12.

Reference Type BACKGROUND
PMID: 24337585 (View on PubMed)

Santoro GA, Wieczorek AP, Dietz HP, Mellgren A, Sultan AH, Shobeiri SA, Stankiewicz A, Bartram C. State of the art: an integrated approach to pelvic floor ultrasonography. Ultrasound Obstet Gynecol. 2011 Apr;37(4):381-96. doi: 10.1002/uog.8816.

Reference Type BACKGROUND
PMID: 20814874 (View on PubMed)

Shobeiri SA, Nolan TE, Yordan-Jovet R, Echols KT, Chesson RR. Digital examination compared to trans-perineal ultrasound for the evaluation of anal sphincter repair. Int J Gynaecol Obstet. 2002 Jul;78(1):31-6. doi: 10.1016/s0020-7292(02)00068-1.

Reference Type BACKGROUND
PMID: 12113968 (View on PubMed)

Other Identifiers

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OstergotlandCC2

Identifier Type: -

Identifier Source: org_study_id

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