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Obstetric anal sphincter injuries detection by digital rectal examination and impedance spectroscopy: post-hoc analysis of the results from a prospective, comparative, multicentre clinical study

Salvatore, S.; Borycka, K.; Ruffolo, A.; Mlynczak, M.; Rosol, M.; Korzeniewski, K.; Iwanowski, P.; Spinelli, A.; de Tayrac, R.; Ratto, C.; Athanasiou, S.; Rizk, D. E. A.; Stuart, A.; Baekelandt, J.; Herman, H.; Janku, P.; Rosenblat, P.; Franco, R.; Grzesiak, M.; Dziki, A.; Fernando, R.

2024-09-19 obstetrics and gynecology
10.1101/2024.09.18.24313868 medRxiv
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BackgroundAccurate diagnosis of obstetric anal sphincter injuries (OASIs) is critical for timely repair and prevention of long-term morbidity, yet digital rectal examination (DRE) remains insufficiently sensitive. MethodsIn this post-hoc analysis of a prospective multicentre diagnostic study (NCT04903977), we compared the diagnostic performance of DRE and machine learning-assisted impedance spectroscopy with three-dimensional endoanal ultrasound (EAUS) as the reference. A total of 152 women who delivered vaginally were assessed up to 8 weeks postpartum. ResultsDRE demonstrated a sensitivity of 44.3%, specificity of 83.5%, and overall accuracy of 67.8%. Impedance spectroscopy achieved 90.6% sensitivity, 84.6% specificity, and 87.0% accuracy against EAUS. ConclusionsDRE frequently fails to detect OASIs postpartum. A minimally invasive, operator-independent impedance-based method significantly improves diagnostic sensitivity and warrants further evaluation for use immediately after delivery to enable timely primary repair.

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