Donald School Journal of Ultrasound in Obstetrics and Gynecology

Register      Login

VOLUME 9 , ISSUE 3 ( July-September, 2015 ) > List of Articles


Sonographic Evaluation of Obstetric Anal Injuries

Aris Antsaklis, Themos Grigoriadis, Sylvia-Christina Mylona, George Giannoulis, Stavros Athanasiou

Keywords : Anal injuries,Postpartum,Ultrasound

Citation Information : Antsaklis A, Grigoriadis T, Mylona S, Giannoulis G, Athanasiou S. Sonographic Evaluation of Obstetric Anal Injuries. Donald School J Ultrasound Obstet Gynecol 2015; 9 (3):266-274.

DOI: 10.5005/jp-journals-10009-1413

License: CC BY-NC 4.0

Published Online: 01-03-2016

Copyright Statement:  Copyright © 2015; The Author(s).


How to cite this article

Grigoriadis T, Mylona SC, Giannoulis G, Athanasiou S, Antsaklis A. Sonographic Evaluation of Obstetric Anal Injuries. Donald School J Ultrasound Obstet Gynecol 2015;9(3):266-274.

PDF Share
  1. Up to seven-fold inter-hospital differences in obstetric anal sphincter injury rates—a birth register-based study in Finland. BMC Res Notes 2010;3(1):345.
  2. Changing incidence of anal sphincter tears in four Nordic countries through the last decades. Eur J Obstet Gynecol Reprod Biol 2009;146(1):71-75.
  3. Frequency of anal sphincter rupture at delivery in Sweden and Finland— result of difference in manual help to the baby's head. Acta Obstet Gynecol Scand 1998;77(10):974-977.
  4. The incidence of obstetric anal sphincter rupture in primiparous women: a comparison between two European delivery settings. Acta Obstet Gynecol Scand 2008;87(2): 209-215.
  5. Trends in risk factors for obstetric anal sphincter injuries in Norway. Obstet Gynecol 2010;116(1):25-34.
  6. Obstetric anal sphincter lacerations. Obstet Gynecol 2001;98(2):225-230.
  7. Fecal and urinary incontinence after vaginal delivery with anal sphincter disruption in an obstetrics unit in the United States. Am J Obstet Gynecol 2003;189(6):1549-1550.
  8. Outcome of primary repair of obstetric anal sphincter injuries (OASIS): does the grade of tear matter? Ultrasound Obstet Gynecol 2010;36(3):368-374.
  9. Methods of repair for obstetric anal sphincter injury: RHL commentary [Internet]. Geneva: World Health Organization. Available at:
  10. Third degree obstetric anal sphincter tears: risk factors and outcome of primary repair. BMJ 1994;308(6933):887-891.
  11. Faecal incontinence. BMJ 1993 Sep 11;307(6905): 636-637.
  12. Long-term ailments due to anal sphincter rupture caused by delivery—a hidden problem. Eur J Obstet Gynecol Reprod Biol 1988;27(1):27-32.
  13. Anal sphincter function after delivery: a prospective study in women with sphincter rupture and controls. Eur J Obstet Gynecol Reprod Biol 1990;35(1):7-13.
  14. A randomized clinical trial comparing primary overlap with approximation repair of third-degree obstetric tears. Am J Obstet Gynecol 2000;183(5):1220-1224.
  15. Obstetric sphincter tears and anal incontinence: an observational follow-up study. Acta Obstet Gynecol Scand 2003;82(10):921-928.
  16. Prevalence of faecal incontinence in adults aged 40 years or more living in the community. Gut 2002;50(4):480-484.
  17. A twisted tale. Clin Risk 2005;11(2):53-56.
  18. ; Martin, JA.; Ventura, SJ. Births: preliminary data for 2009 [Internet]. Available at:
  19. Anal cushions. Lancet 1986;328(8497):42.
  20. Pelvic floor anatomy and applied physiology. Gastroenterol Clin North Am 2008 Sep;37(3):493-509.
  21. Benign Anorectal Diseases: Diagnosis with Endoanal and Endorectal Ultrasound and New Treatment Options. 1st ed. Italy: Springer; 2006. 424 p.
  22. Anatomy and function of the anal longitudinal muscle. Br J Surg 1992;79(9):882-884.
  23. Editorial: Obstetric perineal injury and anal incontinence. AVMA Med Legal J 1999;5(6):193-196.
  24. Management of third- and fourth- degree perineal tears following vaginal delivery [Internet]. London; RCOG Press, 2007. Available at:
  25. ; Christiansen, J.; Butler, U., et al. Anal incontinence. In: Abrams, P.; Cardozo, L.; Khoury, S., et al., editors. Incontinence. 2nd ed. Plymouth: Health Publication Ltd; 2002. p. 985-1044.
  26. Episiotomy and third degree tears. Br J Obstet Gynaecol 1985;92(8):820-823.
  27. Episiotomies and the occurrence of severe perineal lacerations. Br J Obstet Gynaecol 1994;101(12):1064-1067.
  28. Third degree obstetric perineal tears: risk factors and the preventative role of mediolateral episiotomy. Br J Obstet Gynaecol 1997;104(5):563-566.
  29. Obstetric events leading to anal sphincter damage. Obstet Gynecol 1998;92(6):955-961.
  30. Third degree obstetric perineal tear: long-term clinical and functional results after primary repair. Br J Surg 1998;85(10):1433-1438.
  31. Third degree obstetric tears: outcome after primary repair. Acta Obstet Gynecol Scand 1998;77(7):736-740.
  32. Third degree anal sphincter tears: risk factors and outcome. Aust NZ J Obstet Gynaecol 1998; 38(4):414-417.
  33. Primary repair of obstetric anal sphincter rupture using the overlap technique. Br J Obstet Gynaecol 1999;106(4):318-323.
  34. Anal sphincter tears: prospective study of obstetric risk factors. Br J Obstet Gynaecol 2000; 107(7):926-931.
  35. Preventing perineal trauma during childbirth: A systematic review. Obstet Gynecol 2000;95(3):464-471.
  36. Third & fourth degree perineal tears: predictor factors in a referral hospital. Acta Obstet Gynecol Scand 2001;80(3):229-234.
  37. Risk factors for third degree perineal ruptures during delivery. Br J Obstet Gynaecol 2001;108(4):383-387.
  38. Influence of persistent occiput posterior position on delivery outcome. Obstet Gynecol 2001;98(6):1027-1031.
  39. Risk factors for third degree perineal tears in a vaginal delivery with an analysis of episiotomy types. J Reprod Med 2001;46(8):752-756.
  40. Risk factors associated with anal sphincter tear: a comparison of primiparous vaginal births after caesarean deliveries, and patients with previous vaginal delivery. Am J Obstet Gynecol 2002;187(5):1194-1198.
  41. A randomised controlled trial comparing the effects of delayed versus immediate pushing with epidural on mode of delivery and faecal continence. BJOG 2002;109(12):1359-1365.
  42. Risk factors for perineal injury during delivery. Am J Obstet Gynecol 2003;189(1):255-260.
  43. Trends in major risk factors for anal sphincter lacerations: a 10-year study. J Obstet Gynecol Can 2003;25(7):586-593.
  44. Anal endosonography: technique and normal anatomy. Gastrointest Radiol 1989;14(4):349-353.
  45. Anal endosonography and correlation with in vitro and in vivo anatomy. Br J Surg 1993;80(4):508-511.
  46. Anal endosonography for identifying external sphincter defects confirmed histologically. Br J Surg 1994;81(3):463-465.
  47. Examination techniques for endosonography of the anal canal. Abdom Imaging 1998;23(3):301-303.
  48. Endorectal ultrasound (ERUS) in pelvic disorders. Acta Chir Iugosl 2006;53(2):117-120.
  49. Anal endosonography and its role in assessing the incontinent patient. Best Pract Res Clin Obstet Gynaecol 2004 Feb;18(1):157-173.
  50. Three-dimensional endoanalsonography in assessing anal canal injury. Br J Surg 1999;86(3):365-370.
  51. Anal sphincter damage after vaginal delivery using three-dimensional endosonography. Obstet Gynecol 2001;97(5 pt 1):770-775.
  52. Alteration of anal sphincter morphology following vaginal delivery revealed by multiplanar anal endosonography. BJOG 2002;109(8):942-946.
  53. Endoanal ultrasound for detection of sphincter defects following childbirth. Int Urogynecol J 2013 Apr; 24(4):627-635.
  54. Intraobserver and interobserver agreement in anal endosonography. Br J Surg 1999;86(3):371-375.
  55. Ultrasound imaging of the anal sphincter complex: a review. Br J Radiol 2012 Jul;85(1015):865-875.
  56. Normal female anal sphincter: difficulties in interpretation explained. Dis Colon Rectum 2002;45(2):171-175.
  57. Endosonography of the anal sphincter in women of different ages and parity. Ultrasound Obstet Gynecol 2005;25(2):169-176.
  58. Results of endosonographic imaging of the anal sphincter 2-7 days after primary repair of third- or fourth-degree obstetric sphincter tears. Ultrasound Obstet Gynecol 2003 Dec;22(6):609-615.
  59. Three-dimensional endoanal ultrasonography: intraobserver and interobserver agreement using scoring systems for classification of anal sphincter defects. Ultrasound Obstet Gynecol 2009;33(3):337-343.
  60. Anal-sphincter disruption during vaginal delivery. N Engl J Med 1993 Dec 23;329(26):1905-1911.
  61. Occult anal sphincter injuries—myth or reality? Br J Obste Gynaecol 2006;113(2):195-200.
  62. Effect of second vaginal delivery on anorectal physiology and faecal continence: a prospective study. The Lancet 1999;345(9183):983-986.
  63. Diagnosis of anal sphincter tears by postpartum endosonography to predict fecal incontinence. Obstet Gynecol 2000 May;95(5):643-647.
  64. Can we improve the diagnosis of third degree tears? Eur J Obstet Gynecol Reprod Biol 2002;101(1):19-21.
  65. Obstetric perineal trauma: an audit of training. J Obstet Gynaecol 1995;15(1): 19-23.
  66. The extent of endosonographic anal sphincter defects after primary repair of obstetric sphincter tears increases over time and is related to anal incontinence. Ultrasound Obstet Gynecol 2006 Feb;27(2):188-197.
  67. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J 2010 Jan;21(1):5-26.
  68. Is dynamic investigation of the anal sphincter complex useful for assessment of the anal sphincter complex? Ultrasound Obstet Gynecol 2008; 32(3):397.
  69. Vaginal endosonography: a new technique to image the undisturbed anal sphincter. Dis Colon Rectum 1994; 37(12):1296-1299.
  70. A prospective cohort study of women after primary repair of obstetric anal sphincter laceration. Am J Obstet Gynecol 1999;181(6):1317-1322.
  71. Simple ultrasound evaluation of the anal sphincter in female patients using a transvaginal transducer. Ultrasound Obstet Gynecol 2005 Feb;25(2):177-183.
  72. Transvaginal three-dimensional ultrasound: a method of studying anal anatomy and function. Ultrasound Obstet Gynecol 2011 Mar;37(3):353-360.
  73. Vaginal endosonography of the anal sphincter complex is important in the assessment of faecal incontinence and perianal sepsis. Br J Surg 1998;85(3):359-363.
  74. The utility of endovaginal sonography in the evaluation of fecal incontinence. Rev Esp Enferm Dig 2005;97(5):317-322.
  75. Exoanal ultrasound of the anal sphincter: normal anatomy and sphincter defects. Br J Obstet Gynaecol 1997 Sep;104(9): 999-1003.
  76. Ultrasound imaging of the anal sphincter complex: a review. Br J Radiol 2012 Jul;85(1015):865-875.
  77. Postpartum evaluation of the anal sphincter by transperineal three-dimensional ultrasound in primiparous females after vaginal delivery and following surgical repair of third-degree tears by the overlapping technique. Ultrasound Obstet Gynecol 2007; 29(2):195-204.
  78. The prevalence of anal sphincter injury in primiparous women. Ultrasound Obstet Gynecol 2013;42(4):461-466.
  79. Three-dimensional transperineal ultrasonography for evaluation of the anal sphincter complex: another dimension in understanding peripartum sphincter trauma. Ultrasound Obstet Gynecol 2006;27(2):119-123.
  80. State of the art: an integrated approach to pelvic floor ultrasonography. Ultrasound Obstet Gynecol 2011 Apr;37(4):381-396.
  81. Mode of delivery after previous obstetric anal sphincter injuries (OASIS)—a reappraisal? Int Urogynecol J Pelvic Floor Dysfunct 2009;20(9):1095-1101.
  82. Risks of anal incontinence from subsequent vaginal delivery after a complete obstetric anal sphincter tear. Br J Obstet Gynaecol 1992 Sep;99(9):724-726.
  83. Anal and urinary incontinence in women with obstetric anal sphincter rupture. Br J Obstet Gynaecol 1996 Oct;103(10):1034-1040.
  84. Cesarean delivery and anal sphincter injury. Obstet Gynecol 1998 Oct;92(4 Pt 1):496-500.
  85. Third-degree obstetric perineal tear: longterm clinical and functional results after primary repair. Br J Surg 1998 Oct;85(10):1433-1438.
  86. Effect of second vaginal delivery on anal function in patients at risk of occult anal sphincter injury after first forceps delivery. Dis Colon Rectum 2008;51(9):1361-1366.
  87. Three-dimensional transperineal ultrasound findings associated with anal incontinence after intrapartum sphincter tears in primiparous women. Ultrasound Obstet Gynecol 2012 Jan;39(1):83-90.
  88. Outcome of childbirth after previous obstetric anal sphincter injury. Int Urogynecol J 2013;24 Suppl 1:S69-S70.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.