GLUP_Gardone_Valutazione E.M.G. dell’innervazione dello sfintere anale post-parto – D. Riva

1. TASI-2 Preliminary results Diego Riva - Eleonora Raimondi - Corrado Cescon U.O. Ginecologia - Cantù March 2011

2. LISiN Cagliari Riga Berlino Brno Lubiana Cantù Vinnitsa Lodz Trnava Bassano Torino Moncalieri Savigliano Cuneo Asti

3. Bassano Brno Tartu Cuneo Vinnitsa MariaVittoria Moncalieri Savigliano Berlin Cagliari Cantù Como Hildesheim Ljubljana Riga 0 10 20 30 40 50 60 70 80 90 Before Delivery After Delivery Patient recruitment histogram TASI-2 (Total: 20 Hospitals) Hospital Number of Patients Trnava Ferrara Lodz Molinette Asti

6. 0 50 100 150 200 250 300 Number of patients studied Nov-2009 Jun-2010 Sep-2010 Jan-2011 Apr-2011 Time (months) Jun-2011 Dec-2011 POST PRE

7. Introduction ( spontaneous tears or episiotomy ), and subsequent appearance of fecal incontinence in women (Wheeler 2007). A significant correlation exists between tissue lesions which occur during natural childbirth

8. D L V R El.1 El.2 El.3 El.4 El.5 El.6 El.7 El.8 El.9 El.10 El.11 El.12 El.13 El.14 El.15 El.16 Definition of Quadrants of the EAS L-V L-D R-D R-V 5 mm DRP1x16-05-MC

9. Distribution of Episiotomies (N = 47) L-V L-D R-D R-V R-V

10. Patient 1 – Example of episiotomy

11. Pre Partum (Week 34) Post Partum (Week 6) Motor units and Innervation zones – CKC Decomposition

12. Pre Partum (Week 34) Post Partum (Week 6) ARV distribution – MVC uV

13. Pre Partum (Week 31) MUs – IZs distribution ARV map Patient 2 – Example of episiotomy Post Partum (Week 6)

14. Pre Partum (Week 35) MUs – IZs distribution ARV map Patient 3 – Example of episiotomy Post Partum (Week 6)

15. Pre Partum (Week 31) MUs – IZs distribution ARV map Patient 4 – Example of episiotomy Post Partum (Week 6)

16. Pre Partum (Week 33) MUs – IZs distribution ARV map Patient 5 – Example of episiotomy Post Partum (Week 6)

17. Pre Partum (Week 31) MUs – IZs distribution ARV map Patient 6 – Example of episiotomy Post Partum (Week 6)

18. STATISTICAL ANALYSIS

20. From: Enck P, Franz H, Azpiroz F, Fernandez-Fraga X, Hinninghofen H, Kaske-Bretag K, Bottin A, Martina S, Merletti R: Innervation zones of theexternal anal sphincter in healthy male and female subjects: Preliminary results. Digestion 2004;69:123–130. Fig. 4. Histograms of the number of innervation zones (IZ) found under each channel in 15 males (left column) and 37 females (right column) at the depth levels of 1and 2 cm.

22. Quadrant Number of IZ (A.U.) Number of IZ (A.U.) Electrodes 1 16 Number of patients per group: Effect of the number of patients on IZ distrib. Average #MU = 38 4 5 6 8 10 15 20 30 40 50 60 80 100 120 150 200 El.1 El.2 El.3 El.4 El.5 El.6 El.7 El.8 El.9 El.10 El.11 El.12 El.13 El.14 El.15 El.16 L-V L-D R-D R-V

23. Quadrant Number of IZ (A.U.) Number of IZ (A.U.) Electrodes 1 16 Number of patients per group: Effect of the number of patients on IZ distrib. Average #MU = 130 4 5 6 8 10 15 20 30 40 50 60 80 100 120 150 200 El.1 El.2 El.3 El.4 El.5 El.6 El.7 El.8 El.9 El.10 El.11 El.12 El.13 El.14 El.15 El.16 L-V L-D R-D R-V

24. Quadrant Number of IZ (A.U.) Number of IZ (A.U.) Electrodes 1 16 Number of patients per group: Effect of the number of patients on IZ distrib. Average #MU = 381 4 5 6 8 10 15 20 30 40 50 60 80 100 120 150 200 El.1 El.2 El.3 El.4 El.5 El.6 El.7 El.8 El.9 El.10 El.11 El.12 El.13 El.14 El.15 El.16 L-V L-D R-D R-V

25. Quadrant Number of IZ (A.U.) Number of IZ (A.U.) Electrodes 1 16 Number of patients per group: Effect of the number of patients on IZ distrib. Average #MU = 657 4 5 6 8 10 15 20 30 40 50 60 80 100 120 150 200 El.1 El.2 El.3 El.4 El.5 El.6 El.7 El.8 El.9 El.10 El.11 El.12 El.13 El.14 El.15 El.16 L-V L-D R-D R-V

26. Quadrant Number of IZ (A.U.) Number of IZ (A.U.) Electrodes 1 16 Number of patients per group: Effect of the number of patients on IZ distrib. Average #MU = 977 4 5 6 8 10 15 20 30 40 50 60 80 100 120 150 200 El.1 El.2 El.3 El.4 El.5 El.6 El.7 El.8 El.9 El.10 El.11 El.12 El.13 El.14 El.15 El.16 L-V L-D R-D R-V

27. Quadrant Number of IZ (A.U.) Number of IZ (A.U.) Electrodes 1 16 Number of patients per group: Effect of the number of patients on IZ distrib. Average #MU = 1296 4 5 6 8 10 15 20 30 40 50 60 80 100 120 150 200 El.1 El.2 El.3 El.4 El.5 El.6 El.7 El.8 El.9 El.10 El.11 El.12 El.13 El.14 El.15 El.16 L-V L-D R-D R-V

28. 0.5 1 1.5 Mean values of IZ distribution of 4 quadrants 4 5 6 8 10 15 20 30 40 50 60 80 100 120 150 200 0 0.1 0.2 0.3 0.4 0.5 Standard deviations of IZ distribution in 4 quadrants Number of patients per group L-V L-D R-D R-V L-V L-D R-D R-V (normalized values) (normalized values) Effect of the number of patients on IZ distrib.

30. Cesareans: 34 (27%) Episiotomies: 47 (37%) Lacerations: 24 (19%) Vaginal NO damage: 21 (17%) Type of delivery and damage (total: 126)

31. IZ distribution – Caes. Sections (N=34) L-V L-D R-D R-V 0 0.5 1 1.5 2 2.5 3 3.5 Number of IZs Quadrant Caesarean – Pre/Post partum PRE POST

32. IZ distribution – Caes. Sections (N=34)

33. IZ distribution – Lacerations (N=24) L-V L-D R-D R-V 0 0.5 1 1.5 2 2.5 3 3.5 Number of IZs Quadrant Lacerations – Pre/Post partum PRE POST

34. IZ distribution – Lacerations (N=24)

35. IZ distribution – Episiotomies (N=47) L-V L-D R-D R-V 0 0.5 1 1.5 2 2.5 3 3.5 Number of IZs Quadrant Episiotomy – Pre/Post partum * Student T-test p<0,05 PRE POST R-V

36. IZ distribution – Episiotomies (N=47)

37. 0 10 20 30 40 50 60 70 80 Number of patients studied Nov-2009 Jun-2010 Sep-2010 Jan-2011 Apr-2011 Time (months) Jun-2011 Dec-2011 AT1-Berlin AT1-Cagliari AT1-Cantu AT1-Ljubljana AT1-Riga AT2-Vinnitsa AT3-Cuneo AT3-MariaVittoria AT3-Moncalieri AT3-Savigliano