Does trans-perineal ultrasound predict the risk of perineal trauma in women with term pregnancy? A prospective observational study.

Xodo, Serena; Trombetta, Giulia; Morassutto, Caterina; Baccarini, Giovanni; Celante, Lisa; Driul, Lorenza; Londero, Ambrogio

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Original Article

Does trans-perineal ultrasound predict the risk of perineal trauma in women with term pregnancy? A prospective observational study.

Serena Xodo¹

, Giulia Trombetta¹, Caterina Morassutto², Giovanni Baccarini¹, Lisa Celante¹, Lorenza Driul¹, Ambrogio Londero³

¹Clinic of Obstetrics and Gynecology, University of Udine, Udine, Italy
²SC Politiche del Farmaco, Dispositivi Medici e Protesica dell’Azienda Regionale di Coordinamento per la Salute, Udine, Udine, Italy
³Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Infant Health, University of Genoa, Genova, Italy., Genoa, Italy

Corresponding Author: Serena Xodo ,Tel: 0432 -559635, Fax: 0432-559635, Email: serena.xodo@gmail.com

Received: March 15, 2023; Accepted: September 19, 2023. Published online: September 19, 2023.

ABSTRACT

Purpose:
The objectives of this study were to determine the prevalence of perineal trauma during childbirth and to assess the correlation between the pelvic floor dimensions and the fetal head station with the obstetric trauma in a prospectively recruited cohort of women.
Methods:
Women with gestational age > 37 weeks of gestation, singleton pregnancy and fetus in cephalic presentation were included. A TPU was performed before labor onset or labor induction aiming to assess the levator ani muscle (LAM) anteroposterior diameter (APD) and the angle of progression (AoP) either at rest and under maximum Valsalva maneuver and the head-perineum distance (HPD), only at rest.
Results:
Overall, 296 women were included in the analysis. Out of 253 women who delivered vaginally, 19% (48/253) had no perineal trauma, 18.2% (46/253) received an episiotomy during childbirth, 34.4% (87/253) had a first degree laceration, 25,3% (64/253) had a second degree laceration and 3.2% had a third or fourth degree laceration (8/253). Women with episiotomy had a median APD under Valsalva significantly shorter than women without perineal trauma. Moreover women with LAM co-activation (identified by a negative difference between the APD at Valsalva and the APD at rest) had three times higher risk to undergo an operative vaginal delivery and five times higher risk to have a third or fourth degree tear during childbirth than women with a normal relaxation of LAM during Valsalva maneuver.
Conclusion:
The TPU might predict the risk of perineal trauma in women with term pregnancy during childbirth.

Keywords: Transperineal ultrasound; labor; episiotomy; obstetric anal sphincter injury; levator ani muscle; LAM co-activation