الفهرس 
Introduction
Anatomy of pelvic floor, anal sphincter and physiology of ContinenceOnly 14 pages are availabe for public view
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Abstract
Obstetric anal sphincter injuries (OASIS) represent a serious complication of vaginal birth with a negative impact on quality of life and with adverse health-economic effects. OASIS has been reported to be a primary risk factor for the development of anal incontinence (Hals et al., 2010) Childbirth is the main cause of anal incontinence amongst women, who are nine times more likely to experience incontinence than men. (Scheer et al., 2008).The disruption of anal sphincter may be occult without visible perineal laceration, or overt with third- or fourth-degree perineal laceration (Sultan et al., 1993).
Evaluation of the anal sphincter muscle entity is based upon history and physical examination, and upon imaging studies using ultrasound and magnetic resonance imaging (MRI) (Faltin et al., 2000).
Aim of the study
To determine the incidence of obstetric anal sphincter injuries [OASIS] in a cohort of primiparous women during the first year after vaginaldelivery and to assess the role of 2D transperineal ultrasound in evaluating anal sphincter morphology and possible hidden tears.
Patients and methods
The study was designed as a prospective observational study. Was conducted at Women’s Health Hospital, Faculty of medicine Assiut University, during the period from July-2016 to June-2018 the study was conducted in the labour ward (Reception unit).Primiparous women delivered vaginally, were identified prospectively in obstetric log book, their contact details, and delivery data were retrieved from their medical files, then were contacted by phone calls done by the researcher and invited to participate in the study.
Those who agreed to participate were asked to attend the outpatient clinic for evaluation and signing the consent form.
Inclusion criteria: primiparous women with history of vaginal singleton delivery during the last 1 year.
Exclusion criteria: women with a history of chronic intestinal disease (Crohn’s disease, ulcerative colitis), acute gastroenteritis within the week preceding consultation and those who underwent any surgical or diagnostic procedure involving the anal canal and multiparous women.
For the second objective, a control group of primiparous women deliverd by CS was recruited to compare the ultrasound findings with those delivered vaginally with the same inclusion and exclusion criteria.
Patients fulfilling the inclusion and exclusion criteria and consenting to participate in the study were subjected to the following.
History taking, inquiry about clinical data, obstetric data and risk factors for OASIS.
Examination: All patients were subjected to general examination weight including measuring weight, calculation of BMI and pelvic examination to evaluate the anal sphincter condition by inspection then palpation and 2D transperineal ultrasound examination.
The results showed that
No overt OASIS were detected but on PR examination using pill rolling motion to asses thickness of anal sphincter we found that there are 15 cases of vaginal deliveries with poor thickness representing 12.1 % on the other hand in CS cases all of them had normal thickness and using transperineal US for evaluation of anal sphincter we found only 3 cases of vaginal deliveries with disrupted mucosal star sign presented 2.4 % but all Cs cases had intact mucosal star sign.
The combined thickness of the internal and external anal sphincter was significantly thinner in the vaginal delivery group compared with be CS delivery group.