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.