Hans P. Dietz

Description:Corrected: Impact of the type of vaginal assisted delivery on the pelvic floor and OASI – Ultrasound study Jan Dvorak, Renata Poncova, Tomas Fucik ... December 15, 2024 The authors regret putting Table 4 as it does not contain data on OASI, but data presented in Table 4 are on the odds ratio of levator ani avulsion. Data on the odds ratio of OASI are in the text. The authors would like to apologise for any inconvenience caused.

Description:Objective: To compare a standardized interslice interval of 2.5 mm against individualized interslice intervals for exoanal sphincter imaging, in the prediction of anal incontinence, visual analogue scale (VAS) bother score of anal incontinence and St Mark's incontinence score. Methods: This was a cross-sectional study of 1342 women seen between December 2017 and May 2021 for symptoms of pelvic floor dysfunction. All women underwent an interview, including St Mark's score and VAS bother score for anal incontinence, as well as tomographic exoanal sphincter imaging. Tomographic coronal plane slices were obtained by a sonographer blinded to all clinical data, first using individualized interslice intervals of 1.5-4.5 mm and then a second time using an interval of 2.5 mm, performed successively to ensure blinding. Multivariable ordinal and linear regression were employed to assess the association of 'significant residual defects' of the EAS with symptoms of anal incontinence, St Mark's score and VAS bother score of anal incontinence. Cohen's κ was used to determine agreement between the two methods. Results: Of 1342 women seen during the inclusion period, ultrasound volume data were missing in 211 and information on anal incontinence was missing in three, leaving 1128 complete datasets for analysis. Anal incontinence was reported by 253 (22.4%) women, with a mean St Mark's score of 11 (range, 1-22) and a mean VAS bother score of 6 (range, 0-10). Individualization of interslice intervals resulted in a mean ± SD interval of 2.7 ± 0.5 mm (range, 1.5-4.5 mm). There were 429 (38.0%) women who had at least one abnormal external anal sphincter (EAS) slice, and a 'significant residual defect' of the EAS was diagnosed in 138 (12.2%). Reanalysis using a standardized interval of 2.5 mm resulted in abnormal EAS slices in 461 (40.9%) women, with 'significant residual defects' in 134 (11.9%) women. Of the 1128 women, only 28 (2.5%) were classified differently when a 2.5-mm interval was used; agreement between the two methods was high (κ = 0.88). The unadjusted and adjusted models for individualized and standardized interslice intervals did not differ significantly for association with anal incontience. Conclusions: A standardized interslice interval of 2.5 mm does not seem to be less valid for the diagnosis of 'significant residual EAS defect' than individualized interslice intervals. This will help to simplify automated analysis of sphincter imaging. © 2025 International Society of Ultrasound in Obstetrics and Gynecology.

Description:Objective: Obstetric anal sphincter injuries (OASI) and levator ani trauma are common maternal injuries. Our aim was to explore the understanding of these injuries by O&G professionals in addition to their views on antenatal counselling and obtaining informed consent for potential maternal birth injuries. Methods: An online survey was conducted among O&G professionals across 4 metropolitan Sydney Hospitals. It encompasses twenty-four items in four main domains consisting of a series of multiple-choice questions. These four domains are (1) Respondent characteristics; (2) Understanding/teaching of OASI and levator trauma; (3) Views on antenatal counselling; (4) Views on obtaining written informed consent for obstetric interventions. Results: 165 individuals responded (32 %), 65 % were midwives and 30 % were doctors. 99 % of them had prior knowledge of OASI, but this figure was only 62 % for levator trauma. More doctors have heard about levator trauma (94 % vs 50 % for midwives; P < 0.001) and more doctors considered themselves to be very well/well informed of the condition (57 % vs 20 % for midwives, P = 0.002). Adequacy of teaching was considered fair/poor for levator trauma by 78 % of respondents compared to 35 % for OASI. Only 26 % learned about levator trauma mainly from standard teaching. 81 % supported discussion of maternal trauma and 76 % supported obtaining written informed consent for obstetric interventions. Conclusions: Levator trauma is much less well recognized than OASI. A lack of standard teaching may be contributory and may constitute one of the challenges in patient counselling and obtaining informed consent for obstetric interventions, supported by the majority of respondents.

Description:Objective: To evaluate the validity of two-dimensional (2D) oblique parasagittal ultrasound imaging to assess levator ani muscle avulsion. Methods: This was a cross-sectional prospective study of women attending a tertiary urogynecological service between February 2021 and August 2022. All women underwent a standardized interview, pelvic organ prolapse quantification (POP-Q) assessment and four-dimensional transperineal ultrasound. 2D oblique parasagittal ultrasound imaging was performed by rotating the transducer 10-20° from the midline to line up the main transducer axis with the fiber direction of the puborectalis muscle, followed by a full parasagittal sweep of the hiatus at rest. Postprocessing of archived ultrasound volume data was performed at a later date, blinded to all other data. Findings were compared with levator ani assessment results obtained previously using three-dimensional tomographic ultrasound imaging (TUI). Diagnosis of levator ani avulsion on TUI and oblique parasagittal imaging was analyzed for associations with pelvic organ prolapse (POP). Results: The datasets of 484 women were analyzed. Mean age was 58 (range, 16-94) years, mean body mass index was 30 (range, 17-65) kg/m2 and mean parity was 2.6 (range, 0-8). POP symptoms were reported by 278 (57%) women. Clinically and sonographically significant POP was found in 385 (80%) and 350 (72%) women, respectively. Levator ani avulsion was diagnosed in 77 (16%) women on TUI and in 90 (18.6%) women on oblique parasagittal ultrasound imaging, with fair agreement between the two methods (Cohen's kappa of 0.365). There were significant associations between levator ani avulsion on 2D ultrasound imaging and POP diagnosis on clinical examination (odds ratio (OR), 2.88 (95% CI, 1.34-6.18); P = 0.005) and on ultrasound (OR, 2.92 (95% CI, 1.53-5.55); P = 0.001), but these associations were much stronger for TUI (P < 0.001 for both). Conclusions: There was limited agreement between tomographic and oblique parasagittal ultrasound diagnosis of levator ani muscle avulsion. The latter technique has some validity for levator ani assessment but is clearly less valid than TUI. © 2025 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Description:The recently completed Select Committee of the NSW Upper House into Birth Trauma has caused consternation amongst colleagues and triggered a controversial response from the NSW Government. It is high time that our college started to fight back.