- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03912142
Diagnosis of Obstetric Anal Sphincter Injuries (OASIs) Using Transperineal Ultrasound Scan (TPUS)
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Following the first vaginal delivery 85% of women will sustain perineal trauma (1). Sometimes these can extend to the anal sphincter, and these are referred to as Obstetric Anal Sphincter Injuries (OASIs).
Occasionally OASIs may not be detected at delivery. If these tears are missed they would not be repaired and this may lead to incontinence of wind (flatus) or of faeces, both of which can have a significant impact on quality of life.
Endoanal ultrasound (where an ultrasound probe is inserted directly into the back passage) is the gold standard diagnostic tool to detect OASIs. It is however not available in most obstetric units. Transperineal ultrasound (where an ultrasound probe is placed on the perineum)(TPUS) in contrast is available in most obstetric units and therefore we wish to determine whether TPUS in addition to a routine clinical examination will increase the detection rate of OASIs.
Anal incontinence can also occur if the anal sphincter are not repaired adequately. Therefore we want to investigate whether the use of TPUS immediately after primary repair of OASIs is an useful tool to minimise an inadequate repair.
The other aim of the study is to look at changes that occur to the pelvic floor muscles during labour by ultrasound. It is known that certain muscle changes may lead to urinary incontinence and pelvic organ prolapse. However limited studies have evaluated the natural history of the pelvic floor muscles in labour. We therefore wish to perform a transperineal ultrasound each time the midwife or doctor caring for the woman in labour decides the woman in labour needs a vaginal examination. This will provide important information regarding changes that occur to the muscles of the pelvic floor during normal labour.
References:
1)Byrd L,Hobbiss J,Tasker M. Is it possible to predict or prevent third degree tears? Colorectal Dis 2005;7:311-8.
Study Type
Enrollment (Actual)
Contacts and Locations
Study Locations
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London, United Kingdom, SE136LH
- University Hospital Lewisham
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Sampling Method
Study Population
Description
Inclusion Criteria:
- women who are undergoing their first vaginal delivery
- 37 weeks of gestation or more
- a singleton pregnancy
- cephalic presentation
- maternal age 18 years old or more and being able to read and understand English.
Exclusion Criteria:
- Exclusion criteria are those who do not fit in the inclusion criteria.
Study Plan
How is the study designed?
Design Details
- Observational Models: Other
- Time Perspectives: Prospective
Cohorts and Interventions
Group / Cohort |
Intervention / Treatment |
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Three dimensional transperineal ultrasound
This is a single arm study. All women who delivered vaginally will be included in the study . The planned interventions are: Clinical vaginal and rectal examination Three dimensional transperineal ultrasound. |
Diagnostic test: three dimensional transperineal ultrasound scan
Other Names:
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
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Diagnostic test accuracy of three dimensional and transperineal ultrasound (TPUS) for diagnosing Obstetric Anal Sphincter injurieS (OASIS)
Time Frame: immediately Postpartum
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To calculate the diagnostic test characteristics (e.g sensitivity, specificity, positive predictive value, negative predictive value) to enable comparison of 3D TPUS assessment with clinical examination findings of the anal sphincter following vaginal delivery
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immediately Postpartum
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Prevalence of Levator Ani Muscle Injury in women who delivered vaginally and by caesarean section
Time Frame: during first and second stage of labour, immediately Postpartum, 3 months Postpartum and 10-12 weeks Postpartum (in women who deliver vaginally)
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To calculate the prevalence of levator ani muscle avulsion in women after caesarean section and vaginal delivery.
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during first and second stage of labour, immediately Postpartum, 3 months Postpartum and 10-12 weeks Postpartum (in women who deliver vaginally)
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Levator ani muscle hiatus area (cm2)
Time Frame: during first and second stage of labour, immediately Postpartum, 3 months Postpartum and 10-12 weeks Postpartum (in women who deliver vaginally)
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Levator hiatal dimensions can be determined on three dimensional transperineal ultrasound by identifying the plane of minimal dimensions.
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during first and second stage of labour, immediately Postpartum, 3 months Postpartum and 10-12 weeks Postpartum (in women who deliver vaginally)
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Fetal head position
Time Frame: during first and second stage of labour
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Fetal head position is assessed by clinical examination and transabdominal ultrasound.
The possible outcomes of both assessments are occiput anterior, occiput posterior or occiput transverse.
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during first and second stage of labour
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Fetal head station assessed by clinical examination
Time Frame: during first and second stage of labour
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Fetal head station is assessed by clinical examination.
The fetal station is the relationship of the presenting part to the ischial spines.
It is measured in centimetres above or below the ischial spines (+2,+1,0,-1 or -2).
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during first and second stage of labour
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Fetal head station assessed by transperineal ultrasound
Time Frame: during first and second stage of labour
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Transperineal ultrasound is used to assess fetal head station by measuring the angle of progression.
Angle of progression is the angle between the longitudinal axis of the pubic bone and a line joining the lowest edge of the pubis to the fetal skull contour.
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during first and second stage of labour
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Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Ka Woon Wong, MBBS, University Hospital Lewisham
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 196995
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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