BackgroundApproximately 50% women who give birth after obstetric anal sphincter injury (OASI) develop anal incontinence (AI) over their lifetime.ObjectiveTo evaluate current evidence for a protective benefit of planned caesarean section (CS) to prevent AI after OASI.Search StrategyMEDLINE/PubMed, Embase 1974–2024, CINAHL and Cochrane to 7 February 2024 (PROSPERO CRD42022372442).Selection CriteriaAll studies reporting outcomes after OASI and a subsequent birth, by any mode.Data Collection and AnalysisEighty‐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 ResultsThere 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).ConclusionsDue 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.

中文翻译：

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产科肛门括约肌损伤后女性剖腹产和肛门失禁：系统评价和荟萃分析


背景大约 50% 在产科肛门括约肌损伤 (OASI) 后分娩的妇女在其一生中会出现肛门失禁 (AI)。目的评估计划剖腹产 (CS) 对预防 OASI 后 AI 的保护性益处的现有证据。搜索策略MEDLINE/PubMed ，Embase 1974–2024，CINAHL 和 Cochrane 至 2024 年 2 月 7 日（PROSPERO CRD42022372442）。选择标准所有研究报告 OASI 和后续出生后的结果，无论哪种模式。数据收集和分析 2646 项筛选研究中有 86 项符合纳入标准，其中 9 项符合纳入标准适合对 OASI 和随后出生后“调整后的 AI”的主要结果进行荟萃分析的研究。亚组：短期 AI、长期 AI、无症状女性 AI。次要结局：总 AI、生活质量、满意度/遗憾、固体/液体/扁平尿失禁、大便紧迫感、有或没有后续生育的女性的 AI、后续生育前后 AI 的变化。 主要结果 没有证据表明与所有时间段 OASI 后的 CS 相比，随后阴道分娩后调整后的 AI 存在差异（OR = 0.92，95% CI 0.72–1.20；9 项研究，2104 名受试者，我2 = 0% p = 0.58），用于亚组分析或次要结果。没有证据表明生育或未生育的女性的 AI 存在差异（OR = 1.00 95% CI 0.65–1.54；10 项研究，970 名受试者，我2 = 35% p = 0.99），或出生前至出生后（OR = 0.79 95% CI 0.51–1.25；13 项研究，5496 名参与者，我2 = 73% p = 0.31）。结论由于证据质量低，我们无法确定 OASI 后计划剖腹产是否能预防 AI。需要更高质量的证据来指导无症状女性的个性化决策，并确定随后的分娩方式对长期人工智能结果的影响。