Abstract
Objective:
Approximately 50% women who give birth after Obstetric Anal Sphincter
Injury (OASI) develop anal incontinence (AI) over their lifetime. We
review current evidence for protective benefit of planned cesarean
section (CS) to prevent AI after OASI.
Design and setting:
Systematic review and meta-analysis according to prospectively published
methodology.
Population and methods:
All studies reporting outcomes after an OASI and subsequent birth by any
mode.
Main outcome measures:
AI measurement after OASI and subsequent birth. Total AI, new/worsening
AI, quality of life, satisfaction, regret.
Results:
86 of 2472 screened studies met inclusion criteria. All studies
contributing to meta-analyses were at high risk of bias.
There was no evidence of difference in new or worsening AI after
subsequent vaginal birth (VB) compared to subsequent CS after OASI
across all time periods (p=0.53: CI 0.72-1.19; 9 studies, 2104
participants); ≤2y (p=0.83: CI 0.65-1.72; 7 studies, 569 participants)
or ≥5y after subsequent birth (p=0.39: CI 0.65-1.18; 2 studies; 1535
participants). There was no difference between subsequent CS or VB in
asymptomatic women or for other AI or QOL outcomes. There was no
evidence of difference in AI in women who subsequently delivered vs
those who did not (p=0.9: CI 0.71-1.34; 10 studies, 970 participants);
or pre- subsequent birth vs post-subsequent birth (p=0.31; CI 0.51-1.25,
13 studies, 5496 participants).
Conclusions:
Due to evidence quality (majority non-randomised studies) we are unable
to determine whether planned cesarean is protective against AI after
OASI. Higher quality data is required to guide practice in this area,
specifically in asymptomatic women and for long-term outcomes.
Funding:
This study was not externally funded.
Keywords:
Obstetric Anal Sphincter Injury, OASI, OASIS, Anal Incontinence, Mode of
Birth, Shared Decision Making, Cesarean, Vaginal Birth, Planned Birth,
Quality of Life, Recurrent OASI