ArticleInternational urogynecology journal2022
Under-classified obstetric anal sphincter injuries.
Article in International urogynecology journal, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 1 of them a synthesis that pooled it.
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Who cites it
11 citing papers in PubMed, 1 synthesis or guideline pooled it, 30 citations in OpenAlex.
- Effectiveness of education and training programmes to help clinicians assess and classify perineal tears: a systematic review.BMJ open · 2025Pooled it
- Use of endoanal ultrasound in detecting obstetric anal sphincter injury immediately after birth.Acta obstetricia et gynecologica Scandinavica · 2023Trial
- IUGA International Guidelines on Obstetric Anal Sphincter Injuries.International urogynecology journal · 2026Article
- Role of Ultrasound in the Evaluation of Women with Obstetric Anal Sphincter Injuries: Narrative Review.International urogynecology journal · 2026Review
- Urinary incontinence 12 years after obstetric anal sphincter injury in a longitudinal case control study.Scientific reports · 2026Article
- Obstetric Anal Sphincter Injuries: A Urogynecologic Perspective on Detection and Diagnosis.International urogynecology journal · 2025Review
- Artificial intelligence and endoanal ultrasound: pioneering automated differentiation of benign anal and sphincter lesions.Techniques in coloproctology · 2025Article
- Detection of obstetric anal sphincter injuries using machine learning-assisted impedance spectroscopy: a prospective, comparative, multicentre clinical study.Scientific reports · 2025Article
- Family medicine physician identification of obstetric lacerations: a US national survey.International urogynecology journal · 2024Article
- Diagnosis, management and training in perineal trauma: a UK national survey of obstetricians.International urogynecology journal · 2023Article
- Underdiagnosis of internal anal sphincter trauma following vaginal delivery.Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology · 2023Observational
Corrections and comments
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Authors and funding
3 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introduction and hyposthesisObstetric anal sphincter injuries (OASIs) that are missed at delivery can have long-term consequences. OASIs that are under-classified at delivery are likely to be inadequately repaired, resulting in a persistent anal sphincter defect. We aimed to identify women who have persistent defects on endoanal ultrasound, inconsistent with the original diagnosis, and compare the effect on St Mark's incontinence scores (SMIS). We also aimed to look for changes in numbers of under-classification over time.
methodsRecords of women attending a perineal clinic who had endoanal ultrasound from 2012 to 2020 were reviewed. Women who had a modified Starck score implying a defect greater than the classification [indicated by the depth of external anal sphincter or internal anal sphincter (IAS) defect] at delivery were identified.
resultsA total of 1056 women with a diagnosis of 3a or 3b tears were included. Of these, 120 (11.36%) were found to have a defect greater than the original diagnosis and therefore were incorrectly classified at delivery. Women who had a 3b tear diagnosed at delivery, but had an IAS defect, had a significantly higher SMIS (p < 0.01). When comparing two 4-year periods, there was a significant improvement in the diagnosis of IAS tears.
conclusionSome women with OASIs that have under-classified OASIs are associated with worse anorectal symptoms. This is likely because of an incomplete repair. Some improvement in diagnosis of IAS tears has been noted. We propose improved training in OASIs can help reduce the number of incorrectly classified tears and improve repair.
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