Impact of subsequent birth and delivery mode for women with previous OASIS: systematic review and meta-analysis

Abstract

Introduction and hypothesis Obstetric anal sphincter injuries (OASIS) are serious complications of vaginal birth. In a pregnancy following OASIS women may be keen to avoid an elective caesarean section, yet cautious about pursuing another vaginal birth that may result in further damage to the pelvic floor and possible long-term anal incontinence. This review aimed to evaluate the impact of subsequent birth and its mode on anal incontinence (AI) and/or quality of life (QoL), for women with previous OASIS. Methods Searches of MEDLINE, EMBASE, CINAHL, and AMED from inception to February 2016 were undertaken with selection criteria of any study evaluating the effect of a subsequent birth on AI and/or QoL in women with previous OASIS. Where possible, data were extracted to populate 2 × 2 tables and allow meta-analysis relating to the impact of subsequent birth on AI and/or QoL. Results Twenty-seven non-randomised studies were included. Meta-analysis of 14 studies (977 women) did not demonstrate any significant associations between AI in women with previous OASIS and subsequent birth or its mode. Impact on QoL was reported in 12 studies (912 women); however, difference in outcome reporting precluded data meta-analysis. Conclusions Comparisons of outcomes and effective synthesis were limited by sample size, quality and heterogeneity of the studies included. Consequently, the optimal mode of delivery for women with previous OASIS is still not known and better data are needed.

The impact of mode of subsequent birth after obstetric anal sphincter injury on bowel function and related quality of life: a cohort study

“…This present cohort study of consecutive women was also designed to investigate the impact of a subsequent birth by any [4][5][6][7][8][9]. Consequently, this study is of high methodological quality, which limits bias and satisfies the research recommendations highlighted in the published systematic review [3]. Repeat OASI rate in this study was 3.8%, lower than that found in other studies [17].…”

“…Since the introduction of the Royal College of Obstetricians and Gynaecologists (RCOG) Green-top Guideline "The Management of Third-and Fourth-Degree Perineal Tears in 2001" [2], the repair and immediate management of women who sustain OASIS has been standardised and improved. However, the recommendations on mode of birth for women who have a subsequent pregnancy are not based on good evidence from research specifically designed to investigate the effect of mode of subsequent birth on bowel function and quality of life in women with a previous OASI [3].…”

Evolution and risk factors of anal incontinence during the first 6 years after first delivery: a prospective cohort study

“…8,9,11,12 Moreover, a recent systematic review concluded that there is limited evidence on longterm quality of life among women who experience postpartum AI or undergo subsequent deliveries after sustaining OASIS. 13 Non-obstetric factors associated with an increased risk of long-term AI include adverse general health 14,15 and active bowel disease involving diarrhoea or constipation. [16][17][18] In addition, maternal age at first delivery is rising globally.…”

The long-term physical, emotional and psychosexual outcomes related to anal incontinence after severe perineal trauma at childbirth

“…Women who have sustained OASIS at first birth and have a subsequent second pregnancy are exposed to the risk of a repeat OASIS that has been well quantified in the literature 2,3 , and to the potential risk of developing AI that is still to be determined with ongoing research 18 . Even if a repeat OASIS does not occur in the second childbirth, symptoms of AI might still present as a consequence of cumulative pudendal neuropathy, prolonged second labour or even an instrumental delivery at second birth 18 . On the other hand, there are recent reports that the risk of developing long term AI is not associated with the second delivery but only with the severity of OASIS at first childbirth 19 .…”

“…In the case of long-term AI, there are additional factors that have been reported to aggravate the severity of bowel symptoms, such as age and menopause 17 . Women who have sustained OASIS at first birth and have a subsequent second pregnancy are exposed to the risk of a repeat OASIS that has been well quantified in the literature 2,3 , and to the potential risk of developing AI that is still to be determined with ongoing research 18 . Even if a repeat OASIS does not occur in the second childbirth, symptoms of AI might still present as a consequence of cumulative pudendal neuropathy, prolonged second labour or even an instrumental delivery at second birth 18 .…”