Caesarean section in the second delivery to prevent anal incontinence after asymptomatic obstetric anal sphincter injury : the EPIC multicentre randomised trial
© 2020 John Wiley & Sons Ltd..
OBJECTIVE: To determine whether planned caesarean section (CS) for a second delivery protects against anal incontinence in women with obstetric anal sphincter lesions.
DESIGN: Randomised trial.
SETTING: Six maternity units in the Paris area.
SAMPLE: Women at high risk of sphincter lesions (first delivery with third-degree laceration and/or forceps) but no symptomatic anal incontinence.
METHODS: Endoanal ultrasound was performed in the third trimester of the second pregnancy. Women with sphincter lesions were randomised to planned CS or vaginal delivery (VD).
MAIN OUTCOME MEASURES: Anal incontinence at 6 months postpartum. Secondary outcomes were urinary incontinence, sexual morbidity, maternal and neonatal morbidities and worsening of external sphincter lesions.
RESULTS: Anal sphincter lesions were detected by ultrasound in 264/434 women enrolled (60.8%); 112 were randomised to planned VD and 110 to planned CS. At 6-8 weeks after delivery, there was no significant difference in anal continence between the two groups. At 6 months after delivery, median Vaizey scores of anal incontinence were 1 (interquartile range 0-4) in the CS group and 1 (interquartile range 0-3) in the VD group (P = 0.34). There were no significant differences for urinary continence, sexual functions or for other maternal and neonatal morbidities.
CONCLUSIONS: In women with asymptomatic obstetric anal sphincter lesions diagnosed by ultrasound, planning a CS had no significant impact on anal continence 6 months after the second delivery. These results do not support advising systematic CS for this indication.
TWEETABLE ABSTRACT: Caesarean section for the second delivery did not protect against anal incontinence in women with asymptomatic obstetric anal sphincter lesions.
| Errataetall: | |
|---|---|
| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2021 |
|---|---|
| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:128 |
|---|---|
| Enthalten in: |
BJOG : an international journal of obstetrics and gynaecology - 128(2021), 4 vom: 23. März, Seite 685-693 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Abramowitz, L [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
Anal endosonography |
|---|
| Anmerkungen: |
Date Completed 04.03.2021 Date Revised 20.04.2022 published: Print-Electronic CommentIn: BJOG. 2021 Mar;128(4):694-695. - PMID 32894627 Citation Status MEDLINE |
|---|
| doi: |
10.1111/1471-0528.16452 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM313455937 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM313455937 | ||
| 003 | DE-627 | ||
| 005 | 20231225150617.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231225s2021 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1111/1471-0528.16452 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1044.xml |
| 035 | |a (DE-627)NLM313455937 | ||
| 035 | |a (NLM)32770616 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Abramowitz, L |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Caesarean section in the second delivery to prevent anal incontinence after asymptomatic obstetric anal sphincter injury |b the EPIC multicentre randomised trial |
| 264 | 1 | |c 2021 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 04.03.2021 | ||
| 500 | |a Date Revised 20.04.2022 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a CommentIn: BJOG. 2021 Mar;128(4):694-695. - PMID 32894627 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2020 John Wiley & Sons Ltd. | ||
| 520 | |a OBJECTIVE: To determine whether planned caesarean section (CS) for a second delivery protects against anal incontinence in women with obstetric anal sphincter lesions | ||
| 520 | |a DESIGN: Randomised trial | ||
| 520 | |a SETTING: Six maternity units in the Paris area | ||
| 520 | |a SAMPLE: Women at high risk of sphincter lesions (first delivery with third-degree laceration and/or forceps) but no symptomatic anal incontinence | ||
| 520 | |a METHODS: Endoanal ultrasound was performed in the third trimester of the second pregnancy. Women with sphincter lesions were randomised to planned CS or vaginal delivery (VD) | ||
| 520 | |a MAIN OUTCOME MEASURES: Anal incontinence at 6 months postpartum. Secondary outcomes were urinary incontinence, sexual morbidity, maternal and neonatal morbidities and worsening of external sphincter lesions | ||
| 520 | |a RESULTS: Anal sphincter lesions were detected by ultrasound in 264/434 women enrolled (60.8%); 112 were randomised to planned VD and 110 to planned CS. At 6-8 weeks after delivery, there was no significant difference in anal continence between the two groups. At 6 months after delivery, median Vaizey scores of anal incontinence were 1 (interquartile range 0-4) in the CS group and 1 (interquartile range 0-3) in the VD group (P = 0.34). There were no significant differences for urinary continence, sexual functions or for other maternal and neonatal morbidities | ||
| 520 | |a CONCLUSIONS: In women with asymptomatic obstetric anal sphincter lesions diagnosed by ultrasound, planning a CS had no significant impact on anal continence 6 months after the second delivery. These results do not support advising systematic CS for this indication | ||
| 520 | |a TWEETABLE ABSTRACT: Caesarean section for the second delivery did not protect against anal incontinence in women with asymptomatic obstetric anal sphincter lesions | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Randomized Controlled Trial | |
| 650 | 4 | |a Anal endosonography | |
| 650 | 4 | |a anal incontinence | |
| 650 | 4 | |a caesarean section | |
| 650 | 4 | |a obstetric anal sphincter lesion | |
| 700 | 1 | |a Mandelbrot, L |e verfasserin |4 aut | |
| 700 | 1 | |a Bourgeois Moine, A |e verfasserin |4 aut | |
| 700 | 1 | |a Tohic, A L |e verfasserin |4 aut | |
| 700 | 1 | |a Carne Carnavalet, C |e verfasserin |4 aut | |
| 700 | 1 | |a Poujade, O |e verfasserin |4 aut | |
| 700 | 1 | |a Roy, C |e verfasserin |4 aut | |
| 700 | 1 | |a Tubach, F |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t BJOG : an international journal of obstetrics and gynaecology |d 2000 |g 128(2021), 4 vom: 23. März, Seite 685-693 |w (DE-627)NLM10574820X |x 1471-0528 |7 nnns |
| 773 | 1 | 8 | |g volume:128 |g year:2021 |g number:4 |g day:23 |g month:03 |g pages:685-693 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1111/1471-0528.16452 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 128 |j 2021 |e 4 |b 23 |c 03 |h 685-693 | ||