4D-TPUS (Transperineal Ultrasound): Optimizing Feedback for Effective Obstetric Anal Sphincter Injury Repair

Obstetric anal sphincter injuries (OASIS) are a significant risk factor for traumatic anal, fecal, and flatus incontinence in women of reproductive age. Proper recognition and effective surgical repair of these injuries are crucial for ensuring favorable long-term outcomes. In this case report, we describe a nulliparous woman who suffered a fourth-degree perineal tear during childbirth. After the injury was surgically repaired, a four-dimensional transperineal ultrasound (4D-TPUS) was used to evaluate the success of the repair. The ultrasound was performed immediately after the procedure and during follow-up assessments at one and three months post-discharge. Throughout her recovery, the patient reported no incontinence, and the ultrasound imaging revealed no points of discontinuity in the anal sphincter. The use of 4D-TPUS provided valuable feedback, confirming the correct positioning of the stitches and a successful healing process. This case highlights the potential of 4D-TPUS as a useful tool for obstetricians, not only for assessing the success of OASIS repair but also for monitoring the healing process in the postpartum period. Although this technique requires expertise, it proved to be reliable for both immediate and long-term follow-up. Further research is recommended to explore its role in training healthcare providers and enhancing surgical skills in obstetric care. By improving real-time feedback during repair procedures, 4D-TPUS could play a significant role in enhancing patient outcomes and preventing long-term complications associated with obstetric anal injuries.