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Cesarean section in the second delivery to prevent anal incontinence after asymptomatic obstetrical anal sphincter injury: the EPIC multicenter randomized trial
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  • laurent abramowitz,
  • Laurent Mandelbrot,
  • Agnes Bourgeois-Moine,
  • Arnaud Le Tohic,
  • Celine De Carné Carnavalet,
  • Olivier Poujade,
  • Carine Roy,
  • Florence Tubach
laurent abramowitz

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Laurent Mandelbrot
Hopital Louis-Mourier
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Agnes Bourgeois-Moine
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Arnaud Le Tohic
Centre Hospitalier de Versailles Service de Gynecologie et Obstetrique
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Celine De Carné Carnavalet
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Olivier Poujade
Beaujon Hospital, AP-HP
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Carine Roy
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Florence Tubach
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Objective: To determine whether planned cesarean section (CS) for a second delivery protects anal continence in women with obstetrical anal sphincter lesions. Design: Randomized trial. Setting: 6 maternity units in the Paris area. Sample : Women at high risk of sphincter lesions (first delivery with 3d degree laceration and/or forceps) but no symptomatic anal incontinence. Methods : Endoanal ultrasound was performed in the third trimester of the second pregnancy. Women with sphincter lesions were randomized to planned CS or vaginal delivery (VD). Main outcome measures : Anal continence at 6 months post-partum. Secondary outcomes were urinary continence, sexual morbidity, maternal and neonatal morbidities and worsening of external sphincter lesions. Results : Anal sphincter lesions were detected by ultrasound in 264/434 women enrolled (60.8%) ; 112 were randomized to planned VD and 110 to planned CS. At 6-8 weeks after delivery, there was no significant difference in anal continence between the 2 groups. At 6 months after delivery, median Vaizey scores of anal continence were 1 [IQR 0-4] in the CS group and 1 [IQR 0-3] in the VD group (p = 0.34). There were no significant differences for urinary continence, sexual functions or for other maternal and neonatal morbidities. Conclusions : In women with asymptomatic obstetrical anal sphincter lesions diagnosed by ultrasound, planning a CS had no significant impact on anal continence 6 months after the second delivery. These results do not support advising systematic CS for this indication.
24 Feb 2020Submitted to BJOG: An International Journal of Obstetrics and Gynaecology
09 Mar 2020Submission Checks Completed
09 Mar 2020Assigned to Editor
10 Mar 2020Reviewer(s) Assigned
25 Mar 2020Review(s) Completed, Editorial Evaluation Pending
05 May 2020Editorial Decision: Revise Major
03 Jun 20201st Revision Received
08 Jun 2020Submission Checks Completed
08 Jun 2020Assigned to Editor
07 Jul 2020Review(s) Completed, Editorial Evaluation Pending
08 Jul 2020Editorial Decision: Accept