Interventions for women in subsequent pregnancies following obstetric anal sphincter injury to reduce the risk of recurrent injury and associated harms

Abstract

Background: Perineal damage occurs frequently during childbirth, with severe damage involving injury to the anal sphincter reported in up to 18% of vaginal births. Women who have sustained anal sphincter damage are more likely to suffer perineal pain, dyspareunia (painful sexual intercourse), defaecatory dysfunction, and urinary and faecal incontinence compared to those without damage. Interventions in a subsequent pregnancy may be beneficial in reducing the risk of further severe trauma and may reduce the risk of associated morbidities. Objectives: To examine the effects of Interventions for women in subsequent pregnancies following obstetric anal sphincter injury for improving health. Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 September 2014). Selection criteria: Randomised controlled trials, cluster-randomised trials and multi-arm trials assessing the effects of any intervention in subsequent pregnancies following obstetric anal sphincter injury to improve health. Quasi-randomised controlled trials and cross-over trials were not eligible for inclusion. Data collection and analysis: No trials were included. In future updates of this review, at least two review authors will extract data and assess the risk of bias of included studies. Main results: No eligible completed trials were identified. One ongoing trial was identified. Authors' conclusions: No relevant trials were included. The effectiveness of interventions for women in subsequent pregnancies following obstetric anal sphincter injury for improving health is therefore unknown. Randomised trials to assess the relative effects of interventions are required before clear practice recommendations can be made.