loading page

Is Cesarean Section Protective against Anal Incontinence in Women after Obstetric Anal Sphincter Injury (OASI)? A Systematic Review and Meta-Analysis
  • +2
  • Emily Carter,
  • Rebecca Hall,
  • Kelechi Ajoku,
  • Jenny Myers,
  • Rohna Kearney
Emily Carter
Manchester University NHS Foundation Trust

Corresponding Author:[email protected]

Author Profile
Rebecca Hall
Manchester University NHS Foundation Trust
Author Profile
Kelechi Ajoku
Manchester University NHS Foundation Trust
Author Profile
Jenny Myers
The University of Manchester Faculty of Biology Medicine and Health
Author Profile
Rohna Kearney
Manchester University NHS Foundation Trust
Author Profile

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.
31 Oct 2023Submitted to BJOG: An International Journal of Obstetrics and Gynaecology
09 Nov 2023Submission Checks Completed
09 Nov 2023Assigned to Editor
09 Nov 2023Review(s) Completed, Editorial Evaluation Pending
16 Nov 2023Reviewer(s) Assigned
29 Feb 20241st Revision Received
05 Mar 2024Submission Checks Completed
05 Mar 2024Assigned to Editor
05 Mar 2024Review(s) Completed, Editorial Evaluation Pending
18 Jun 2024Editorial Decision: Accept