European journal of obstetrics, gynecology, and reproductive biology · 2025
The sonographic subpubic area is a predictor of anal incontinence after a first vaginal delivery: A prospective cohort study.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Packet Bram, Van Severen Rik, Cattani Laura, Samesova Adela, Ramakers Florian, Williams Helena, Richter Jute, Deprest Jan
Аннотация
OBJECTIVES: To study the association between the subpubic arch angle and area, the latter a novel estimator of maternal pelvic outlet dimensions, and postpartum anal incontinence.
METHODS: Convenience sample from a prospective observational cohort study conducted in primiparous women who delivered vaginally at term. A transperineal ultrasound (TPUS) volume was acquired before the second stage for offline measurement of the subpubic arch angle, area, and levator ani hiatal area. Six to eight weeks postpartum, anal incontinence was self-reported using the St. Marks Incontinence Score (SMIS), and perineal and pelvic floor muscle structural changes were assessed by TPUS. Intra and inter-observer agreement on subpubic arch angle and area measurements was assessed. Anal incontinence and its potential predictors were studied in multivariable logistic regression. Last, a prediction model for postpartum anal incontinence was fitted based on antenatal predictors (age, BMI, anal incontinence at term). Individual sonographic variables were added to this baseline model to assess whether they influenced discriminatory accuracy by comparing the AUC.
RESULTS: Data on 156 participants were available, of whom 73.7 % delivered spontaneously. Postpartum anal respective fecal incontinence was reported by 70.5 % and 7.7 %. The incidence of obstetric anal sphincter injury was 3.8 %. Inter- and intra-rater agreement was better for the subpubic area (ICC 0.95, 95 % CI 0.92-0.97 and ICC 0.97, 95 % CI 0.95-0.98) than the subpubic arch angle. Anal incontinence at term (aOR 3.77, 95 % CI1.46-9.73) and assisted vaginal birth (aOR 4.05, 95 %CI 1.27-12.92) were the strongest predictors of postpartum anal incontinence. Although less strong, the subpubic area was also an independent predictor (aOR 1.44, 95 %1.08-1.93). Addition of the subpubic area to the antenatal model did not improve discriminatory accuracy (AUC baseline model: 0.70, 95 % CI 0.61-0.80).
CONCLUSION: The subpubic area can be reliably measured on TPUS. Herein, it was an independent predictor of postpartum anal incontinence. Nonetheless, the addition of this variable to a model containing antenatal predictors only, did not improve discriminatory accuracy for postpartum anal incontinence, questioning its added value for individualized risk prediction.
FUNDING: Research Council Flanders (grant number 1S49923N).
METHODS: Convenience sample from a prospective observational cohort study conducted in primiparous women who delivered vaginally at term. A transperineal ultrasound (TPUS) volume was acquired before the second stage for offline measurement of the subpubic arch angle, area, and levator ani hiatal area. Six to eight weeks postpartum, anal incontinence was self-reported using the St. Marks Incontinence Score (SMIS), and perineal and pelvic floor muscle structural changes were assessed by TPUS. Intra and inter-observer agreement on subpubic arch angle and area measurements was assessed. Anal incontinence and its potential predictors were studied in multivariable logistic regression. Last, a prediction model for postpartum anal incontinence was fitted based on antenatal predictors (age, BMI, anal incontinence at term). Individual sonographic variables were added to this baseline model to assess whether they influenced discriminatory accuracy by comparing the AUC.
RESULTS: Data on 156 participants were available, of whom 73.7 % delivered spontaneously. Postpartum anal respective fecal incontinence was reported by 70.5 % and 7.7 %. The incidence of obstetric anal sphincter injury was 3.8 %. Inter- and intra-rater agreement was better for the subpubic area (ICC 0.95, 95 % CI 0.92-0.97 and ICC 0.97, 95 % CI 0.95-0.98) than the subpubic arch angle. Anal incontinence at term (aOR 3.77, 95 % CI1.46-9.73) and assisted vaginal birth (aOR 4.05, 95 %CI 1.27-12.92) were the strongest predictors of postpartum anal incontinence. Although less strong, the subpubic area was also an independent predictor (aOR 1.44, 95 %1.08-1.93). Addition of the subpubic area to the antenatal model did not improve discriminatory accuracy (AUC baseline model: 0.70, 95 % CI 0.61-0.80).
CONCLUSION: The subpubic area can be reliably measured on TPUS. Herein, it was an independent predictor of postpartum anal incontinence. Nonetheless, the addition of this variable to a model containing antenatal predictors only, did not improve discriminatory accuracy for postpartum anal incontinence, questioning its added value for individualized risk prediction.
FUNDING: Research Council Flanders (grant number 1S49923N).