Caesarean section and anal incontinence in women after obstetric anal sphincter injury: A systematic review and meta-analysis.

IF 5.4 3区材料科学 Q2 CHEMISTRY, PHYSICAL

ACS Applied Energy Materials Pub Date : 2024-07-04 DOI:10.1111/1471-0528.17899

Emily Carter, Rebecca Hall, Kelechi Ajoku, Jenny Myers, Rohna Kearney

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引用次数: 0

Abstract

Background: Approximately 50% women who give birth after obstetric anal sphincter injury (OASI) develop anal incontinence (AI) over their lifetime.

Objective: To evaluate current evidence for a protective benefit of planned caesarean section (CS) to prevent AI after OASI.

Search strategy: MEDLINE/PubMed, Embase 1974-2024, CINAHL and Cochrane to 7 February 2024 (PROSPERO CRD42022372442).

Selection criteria: All studies reporting outcomes after OASI and a subsequent birth, by any mode.

Data collection and analysis: Eighty-six of 2646 screened studies met inclusion criteria, with nine studies suitable to meta-analyse the primary outcome of 'adjusted AI' after OASI and subsequent birth. Subgroups: short-term AI, long-term AI, AI in asymptomatic women.

Secondary outcomes: total AI, quality of life, satisfaction/regret, solid/liquid/flatal incontinence, faecal urgency, AI in women with and without subsequent birth, change in AI pre- to post- subsequent birth.

Main results: There was no evidence of a difference in adjusted AI after subsequent vaginal birth compared with CS after OASI across all time periods (OR = 0.92, 95% CI 0.72-1.20; 9 studies, 2104 participants, I² = 0% p = 0.58), for subgroup analyses or secondary outcomes. There was no evidence of a difference in AI in women with or without subsequent birth (OR = 1.00 95% CI 0.65-1.54; 10 studies, 970 participants, I² = 35% p = 0.99), or pre- to post- subsequent birth (OR = 0.79 95% CI 0.51-1.25; 13 studies, 5496 participants, I² = 73% p = 0.31).

Conclusions: Due to low evidence quality, we are unable to determine whether planned caesarean is protective against AI after OASI. Higher quality evidence is required to guide personalised decision-making for asymptomatic women and to determine the effect of subsequent birth mode on long-term AI outcomes.

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剖腹产与产科肛门括约肌损伤后妇女的肛门失禁：系统回顾和荟萃分析。

背景：产科肛门括约肌损伤（OASI）后分娩的妇女中约有50%终生发展为肛门失禁（AI）：目的：评估计划剖腹产（CS）对预防肛门括约肌损伤后肛门失禁有保护作用的现有证据：检索策略：MEDLINE/PubMed、Embase 1974-2024、CINAHL 和 Cochrane，检索期至 2024 年 2 月 7 日（PROSPERO CRD42022372442）：数据收集与分析：在筛选出的 2646 项研究中，有 86 项符合纳入标准，其中有 9 项研究适合对 OASI 和后续生育后的 "调整后 AI "这一主要结果进行元分析。次要结果：总AI、生活质量、满意度/遗憾、固体/液体/肛门失禁、粪便急迫性、有和没有随后生育的妇女的AI、AI在生育前和生育后的变化：在亚组分析或次要结果方面，没有证据表明在所有时间段内，阴道分娩后的调整后AI与OASI后的CS相比存在差异（OR = 0.92，95% CI 0.72-1.20；9项研究，2104名参与者，I2 = 0% p = 0.58）。没有证据表明有无后继生育的妇女的人工指数存在差异（OR = 1.00 95% CI 0.65-1.54；10 项研究，970 名参与者，I2 = 35% p = 0.99），或后继生育前与后继生育后的妇女的人工指数存在差异（OR = 0.79 95% CI 0.51-1.25；13 项研究，5496 名参与者，I2 = 73% p = 0.31）：由于证据质量较低，我们无法确定计划剖腹产是否可预防 OASI 后的人工流产。需要更高质量的证据来指导无症状妇女的个性化决策，并确定后续分娩方式对长期人工流产结局的影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

ACS Applied Energy Materials Materials Science-Materials Chemistry

CiteScore

10.30

自引率

6.20%

发文量

1368

期刊介绍： ACS Applied Energy Materials is an interdisciplinary journal publishing original research covering all aspects of materials, engineering, chemistry, physics and biology relevant to energy conversion and storage. The journal is devoted to reports of new and original experimental and theoretical research of an applied nature that integrate knowledge in the areas of materials, engineering, physics, bioscience, and chemistry into important energy applications.