Three-dimensional endoanal ultrasound assessment of the anal sphincters during rest and squeeze.

BACKGROUND: Current ultrasound assessment of the anal sphincter is based on measurements during rest. However, active constriction plays a role in maintaining continence. Here we assess female anal dimensions during rest and squeeze. METHODS: Thirty women were recruited for a cross-sectional endoanal ultrasound study after written consent according to an ethically approved protocol: nine 0-gravida, 10 with normal vaginal delivery, and 11 with complicated vaginal delivery (babies >4,500 g, operative vaginal delivery or perineal rupture). Endoanal three-dimensional (3D)-ultrasound volume was obtained during rest and squeeze. Length of anal canal and volume of the external and internal sphincters were determined. RESULTS: In the 0-gravida group, the mean anal canal at rest was 3.28 cm (SD: +/-0.63) compared with 2.30 (+/-0.77) in those who had given birth (p =0.002). Correspondingly, the volume of the external sphincter was 7.61 cm(3) (+/-2.63) versus 4.80 (+/-2.02) (p =0.004), and for the internal sphincter 2.63 (+/-1.18) versus 2.68 (+/-1.30) (p =0.98). There were no differences between rest and squeeze within the 0-gravida, but after a traumatic vaginal delivery the internal sphincter was smaller during squeeze (p =0.01), and the overlap between external and internal sphincter was 0.76 cm (+/-0.41), insignificantly shorter (p =0.09) than in the 0-gravida group at 1.21 (+/-0.62). CONCLUSIONS: Women with vaginal delivery had a shorter anal canal and smaller external sphincter than 0-gravida. Active squeeze had no effect on the dimensions of the sphincter apart from a reduction of the internal sphincter in those who had undergone a complicated delivery, possibly due to a dislodging upwards during squeeze.

Three-dimensional endoanal ultrasound assessment of the anal sphincters: reproducibility.

OBJECTIVE: Volume measurement of the anal sphincter can be a future method for assessing volume loss, muscle atrophy or laceration. Three-dimensional (3D) endoanal ultrasound is a technique for assessing the volume of the anal sphincters, but the reproducibility of the method is scarcely known. DESIGN: Cross-sectional, repeated measurements. SAMPLE: Twenty women were recruited for the study after written consent according to an ethically approved protocol, nine 0-gravida and 11 with traumatic vaginal deliveries. METHOD: Endoanal 3D-ultrasound volume was obtained during rest and squeeze. The length of the anal canal and the volume of the external and internal sphincters were determined by two observers. Observer 1 repeated the measurements three times for all 20 women, and observer 2 for the nine 0-gravida, and intra- and inter-observer variation was assessed. RESULTS: During rest, the anal length measurement had intra-class correlation coefficients of 0.91 for observer 1 and 0.85 for observer 2. The limits of agreement for inter-observer measurement were (-0.81 to 1.61) measured in centimeters. For the external anal sphincter volume, the intra-class correlation coefficients and the limits of agreement were correspondingly: 0.89, 0.78 and (-7.29 to 6.03) measured in cm(3), and for the internal anal sphincter volume: 0.85, 0.69 and (-1.72 to 2.95). The variation in identifying the external anal sphincter could rise to a corresponding 30% error in volume measurement. CONCLUSION: Although intra-class correlation coefficients showed good reproducibility for endoanal ultrasound measurements, the limits of agreement were less reassuring with sizeable variation in the volume assessment, probably due to uncertainty in landmark identification.

[Is antibiotic prophylaxis in Cesarean section necessary?]. / Er antibiotikaprofylakse ved keisersnitt nødvendig?

BACKGROUND: A Cochrane Review from October 1998 recommends prophylactic antibiotics for all women undergoing elective and non-elective caesarean section. This is expected to reduce the frequency of postoperative endometritis by two thirds to three quarters. In this study we evaluate the infection rate after caesarean section in a hospital where prophylactic antibiotics are given only to high-risk groups. METHODS: Case records of 344 patient delivered by caesarean section were studied. 30 days after the operation, 83% answered a questionnaire about wound infection. RESULTS: In all, 39% received prophylactic antibiotics. 33 patients (9.6%) developed post-cesarean infections; only 17 were given antibiotic treatment. One patient had endometritis. There were no significant differences with regard to infections between the elective and the non-elective groups (p = 0.63), or between those receiving and those not receiving antibiotic prophylaxis (p = 0.84). CONCLUSION: The policy of selective use of prophylactic antibiotics for caesarean sections has been successful in our hospital. This study does not permit conclusions as to whether selective prophylactics is a better alternative than routine prophylactics, but the results question whether the recommendation in the Cochrane Review is the best choice for all delivery units.