Postpartum perineal wound infection and its effect on anal sphincter integrity: Results of a prospective observational study
Abstract Introduction Perineal wound infection can affect tissues at superficial, deep, and organ space levels. Women with obstetric anal sphincter injuries (OASIS) are at risk of infection; however, no study to date has investigated if infection can extend to affect the anal sphincter integrity. Th...
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Wiley
2023-04-01
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| Series: | Acta Obstetricia et Gynecologica Scandinavica |
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| Online Access: | https://doi.org/10.1111/aogs.14515 |
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| author | Nicola Adanna Okeahialam Ranee Thakar Abdul H. Sultan |
| author_facet | Nicola Adanna Okeahialam Ranee Thakar Abdul H. Sultan |
| author_sort | Nicola Adanna Okeahialam |
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| description | Abstract Introduction Perineal wound infection can affect tissues at superficial, deep, and organ space levels. Women with obstetric anal sphincter injuries (OASIS) are at risk of infection; however, no study to date has investigated if infection can extend to affect the anal sphincter integrity. The aim of this study was to evaluate the clinical progression of perineal wound infection and its effect on the anal sphincter in women with or without OASIS using three‐dimensional endoanal ultrasound (3D‐EAUS). Material and methods Women were recruited into the Prospective Observational Study Evaluating the Sonographic Appearance of the Anal Sphincter in Women With Perineal Wound Infection Following Vaginal Delivery (PERINEAL Study) between August 2020 and August 2021 (NCT 04480684). 3D‐EAUS was performed weekly until complete wound healing. Significant bacterial colonization was diagnosed using the MolecuLight i:X camera. The primary study outcome was a change in a sphincter defect angle from baseline (wound infection) until wound healing. A robust Poisson regression model was used to analyze the effect of significant bacterial loads on the anal sphincter. Results Seventy‐three women were included. A median of two ultrasound scans were performed in each patient (range 1–16). Five women (6.8%) had an OASI clinically diagnosed at delivery. In total, 250 EAUS were performed. An external anal sphincter defect was found on EAUS in 55 (22.0%) scans (n = 10 women). An external anal sphincter and internal anal sphincter defect was found in 26 scans (10.4%) (n = 3 women). During the course of the wound healing process, there was no significant change in defect size in wounds with or without significant bacterial colonization. In cases of an intact anal sphincter, wound infection did not disrupt its integrity. Conclusions We found that perineal wound infection does not disrupt an intact anal sphincter or OASIS. This new information can provide important information for clinicians and patients. As there are myths frequently encountered in cases of litigation when disruption of sphincter integrity is attributed to perineal infection, the findings of this study should be tested in larger studies in the future. |
| format | Article |
| id | doaj-art-03ecc498e5dc4e8997af2af1a1e2f654 |
| institution | OA Journals |
| issn | 0001-6349 1600-0412 |
| language | English |
| publishDate | 2023-04-01 |
| publisher | Wiley |
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| series | Acta Obstetricia et Gynecologica Scandinavica |
| spelling | doaj-art-03ecc498e5dc4e8997af2af1a1e2f6542025-08-20T02:36:36ZengWileyActa Obstetricia et Gynecologica Scandinavica0001-63491600-04122023-04-01102447347910.1111/aogs.14515Postpartum perineal wound infection and its effect on anal sphincter integrity: Results of a prospective observational studyNicola Adanna Okeahialam0Ranee Thakar1Abdul H. Sultan2Croydon University Hospital Croydon UKCroydon University Hospital Croydon UKCroydon University Hospital Croydon UKAbstract Introduction Perineal wound infection can affect tissues at superficial, deep, and organ space levels. Women with obstetric anal sphincter injuries (OASIS) are at risk of infection; however, no study to date has investigated if infection can extend to affect the anal sphincter integrity. The aim of this study was to evaluate the clinical progression of perineal wound infection and its effect on the anal sphincter in women with or without OASIS using three‐dimensional endoanal ultrasound (3D‐EAUS). Material and methods Women were recruited into the Prospective Observational Study Evaluating the Sonographic Appearance of the Anal Sphincter in Women With Perineal Wound Infection Following Vaginal Delivery (PERINEAL Study) between August 2020 and August 2021 (NCT 04480684). 3D‐EAUS was performed weekly until complete wound healing. Significant bacterial colonization was diagnosed using the MolecuLight i:X camera. The primary study outcome was a change in a sphincter defect angle from baseline (wound infection) until wound healing. A robust Poisson regression model was used to analyze the effect of significant bacterial loads on the anal sphincter. Results Seventy‐three women were included. A median of two ultrasound scans were performed in each patient (range 1–16). Five women (6.8%) had an OASI clinically diagnosed at delivery. In total, 250 EAUS were performed. An external anal sphincter defect was found on EAUS in 55 (22.0%) scans (n = 10 women). An external anal sphincter and internal anal sphincter defect was found in 26 scans (10.4%) (n = 3 women). During the course of the wound healing process, there was no significant change in defect size in wounds with or without significant bacterial colonization. In cases of an intact anal sphincter, wound infection did not disrupt its integrity. Conclusions We found that perineal wound infection does not disrupt an intact anal sphincter or OASIS. This new information can provide important information for clinicians and patients. As there are myths frequently encountered in cases of litigation when disruption of sphincter integrity is attributed to perineal infection, the findings of this study should be tested in larger studies in the future.https://doi.org/10.1111/aogs.14515bacterial autofluorescenceendoanal ultrasoundobstetric anal sphincter injuryperineal wound infectionsevere perineal lacerationthird‐degree tears |
| spellingShingle | Nicola Adanna Okeahialam Ranee Thakar Abdul H. Sultan Postpartum perineal wound infection and its effect on anal sphincter integrity: Results of a prospective observational study Acta Obstetricia et Gynecologica Scandinavica bacterial autofluorescence endoanal ultrasound obstetric anal sphincter injury perineal wound infection severe perineal laceration third‐degree tears |
| title | Postpartum perineal wound infection and its effect on anal sphincter integrity: Results of a prospective observational study |
| title_full | Postpartum perineal wound infection and its effect on anal sphincter integrity: Results of a prospective observational study |
| title_fullStr | Postpartum perineal wound infection and its effect on anal sphincter integrity: Results of a prospective observational study |
| title_full_unstemmed | Postpartum perineal wound infection and its effect on anal sphincter integrity: Results of a prospective observational study |
| title_short | Postpartum perineal wound infection and its effect on anal sphincter integrity: Results of a prospective observational study |
| title_sort | postpartum perineal wound infection and its effect on anal sphincter integrity results of a prospective observational study |
| topic | bacterial autofluorescence endoanal ultrasound obstetric anal sphincter injury perineal wound infection severe perineal laceration third‐degree tears |
| url | https://doi.org/10.1111/aogs.14515 |
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