为产科肛门括约肌损伤的妇女提供咨询--复发风险和第二次分娩方式对后续肛门失禁的影响--系统回顾和荟萃分析

IF 2.1 4区医学 Q2 OBSTETRICS & GYNECOLOGY

European journal of obstetrics, gynecology, and reproductive biology Pub Date : 2025-03-11 DOI:10.1016/j.ejogrb.2025.03.018

Ella-Josephine Mørch , Kathrine Perslev , Tine Wrønding , Anna Aabakke , ·Hanna Jangö

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Counseling women with obstetric anal sphincter injury – Risk of recurrence and the influence of mode of second delivery on subsequent anal incontinence – A systematic review and meta-analysis

Obstetric anal sphincter injury (OASI) is a severe complication of vaginal delivery. Up to 50% of women with OASI will experience anal incontinence at long-term. However, it is uncertain whether an elective cesarean section (CS) in a subsequent pregnancy following OASI decreases the risk of anal incontinence. The aim of this study was to assess the risk of recurrent OASI in a subsequent pregnancy after a first delivery with OASI. Additionally, we wanted to evaluate the impact of recurrent OASI on the risk of anal incontinence, and to determine whether the CS was protective against anal incontinence in women with a first delivery with OASI.

Literature searches were made in PubMed, Cochrane, and Embase, the last search was made in May 2024. Studies were screened and study quality was assessed using “SIGN – Methodology Checklist”.

Thirteen studies (including 3 020 897 women) were included in the meta-analysis on risk of recurrent OASI. OASI in the first delivery increased the risk of recurrent OASI in the second delivery fivefold compared to women without previous OASI OR 4.9 (95%CI 4.0–5.9). The overall risk of acquiring a recurrent OASI was 6.1% (95%CI 5.9%-6.2%).

Five studies (including 2 330 women) were included in the meta-analysis assessing the effect of mode of subsequent delivery on anal incontinence. The risk of anal incontinence was non-significantly increased in women with a second vaginal delivery OR 1.1 (95%CI 0.9–1.4). Four studies (including 2 300 women) were included in the meta-analysis on the risk of developing anal incontinence after recurrent OASI. The risk of anal incontinence was increased in women with recurrent OASI compared to women with OASI in the first delivery and a subsequent delivery without OASI OR 1.6 (95%CI 1.3–2.0).

In conclusion, we found an increased risk of recurrent OASI in the second delivery for women with a previous OASI, compared to women without previous OASI. The risk of anal incontinence was increased in women with recurrent OASI. The risk of new onset or worsening of anal incontinence was not associated with mode of the second delivery. Women with previous OASI should be informed about the increased risk of recurrence and that elective CS is not necessarily protective against anal incontinence.

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来源期刊

European journal of obstetrics, gynecology, and reproductive biology 医学-妇产科学

CiteScore

4.60

自引率

3.80%

发文量

898

审稿时长

8.3 weeks

期刊介绍： The European Journal of Obstetrics & Gynecology and Reproductive Biology is the leading general clinical journal covering the continent. It publishes peer reviewed original research articles, as well as a wide range of news, book reviews, biographical, historical and educational articles and a lively correspondence section. Fields covered include obstetrics, prenatal diagnosis, maternal-fetal medicine, perinatology, general gynecology, gynecologic oncology, uro-gynecology, reproductive medicine, infertility, reproductive endocrinology, sexual medicine and reproductive ethics. The European Journal of Obstetrics & Gynecology and Reproductive Biology provides a forum for scientific and clinical professional communication in obstetrics and gynecology throughout Europe and the world.