Rectal Examination
In order to evaluate the anal sphincter pressure of the patients, we
used the digital rectal examination scoring system (DRESS) by performing
a rectal examination after the ultrasound acquisition was completed. The
DRES System uses an analog scale of 0 to 5. During rectal examination,
separate numbers are assigned to the resting and maximum squeeze
pressure. A score of 3 is normal. A rest score of 5 indicates very high
pressures and a tight anal canal, while a score of 0 indicates an open
anal canal at rest with the hips split. A squeeze score of 5 indicates a
very strong squeeze that was almost painful to the exam, while a score
of 0 indicates no increase in pressure noticeable from resting with
maximum patient effort. The DRESS score is a validated system which is
correlated very well with manometer pressures for resting pressure and
squeeze pressure.14
After the vaginal delivery, the participants were divided into two
groups: the fundal pressure group included women where the fundal
pressure maneuver was applied (n = 37); and the control group
included women who delivered spontaneously without fundal pressure
(n = 36). Demographic and obstetric data including age, body mass
index (BMI), fetal height, fetal weight, fetal bi-parietal diameter
(BPD), head circumference (HC) and duration of the first stage of
delivery. The duration of the second stage of delivery, defined as the
period from full dilation of the cervix until complete expulsion of the
baby, was noted. Furthermore, data on the need for episiotomy, the
number of fundal pressure trials, labour complications and 3D-TPU
findings were documented.