Perineal Echography in the Delivery Room for the Detection of Anal Lesions

• Wexner anal incontinence score [ Time Frame: 3 months ] [ Designated as safety issue: No ]
• Visual Analog Scale for discomfort during perineal ultrasound [ Time Frame: 2 hours ] [ Designated as safety issue: No ]
  Ranges from 0.0 to 10.0
• Kappa coefficient for second reading of ultrasounds [ Time Frame: 30 days ] [ Designated as safety issue: No ]
  A second reading of each ultrasound is obtained within 30 days. The Kappa coefficient of concordance will be calculated between the two readings.
• Presence/absence of a sphincter tear [ Time Frame: 2 hours ] [ Designated as safety issue: No ]
  Presence/absence of a sphincter tear immediately after delivery.
• Patient requires anal sutures (yes/no) [ Time Frame: 2 hours ] [ Designated as safety issue: No ]
  Patient requires anal sutures after delivery?
• Presence/absence of suture infection [ Time Frame: 3 months ] [ Designated as safety issue: No ]
  Has an infection ocurred between delivery and the follow up visit at 3 months post partum?
• Questionnaire PFIQ [ Time Frame: 3 months ] [ Designated as safety issue: No ]
• Questionnaire PFDI [ Time Frame: 3 months ] [ Designated as safety issue: No ]
• Questionnaire SF36 [ Time Frame: 3 months ] [ Designated as safety issue: No ]
• Questionnaire Euroqol [ Time Frame: 3 months ] [ Designated as safety issue: No ]

The main objective of this study is to compare the rate of anal incontinence (measured by the Wexner score, qualitative and quantitative (> 4)) at 3 months post partum among primiparas with vaginal tears ≥ 2nd degree who receive a sphincter injury screening at delivery by conducting a sphincter ultrasound in the delivery room versus a similar group of women who do not benefit from screening.

• Experimental: Experimental arm
  In this arm, perineal ultrasound is used directly after delivery in order to hypothetically better detect anal lesions.
  Intervention: Procedure: Perineal ultrasound
• No Intervention: Standard arm
  No perineal ultrasound immediately after delivery.

Inclusion Criteria:

• The patient must have given his/her informed and signed consent
• The patient must be insured or beneficiary of a health insurance plan
• The patient is available for 3 months of follow up
• The patient is delivering her first child; vaginal delivery
• The patient has a minimum stage 2 perineal lesion
• The patient accepts perineal echography

Exclusion Criteria:

• The patient is under judicial protection, under tutorship or curatorship
• The patient refuses to sign the consent
• It is impossible to correctly inform the patient
• Cesarien section
• No perineal lesion (intact perineum)
• Emergency situation which hinders screening for anal lesions under good medical conditions
• Previous vaginal delivery