{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T23:00:29Z","timestamp":1791241229881,"version":"4.1.0"},"reference-count":33,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2020,9,6]],"date-time":"2020-09-06T00:00:00Z","timestamp":1599350400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2021,3]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To determine whether planned caesarean section (CS) for a second delivery protects against anal incontinence in women with obstetric anal sphincter lesions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Randomised trial.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Six maternity units in the Paris area.<\/jats:p><\/jats:sec><jats:sec><jats:title>Sample<\/jats:title><jats:p>Women at high risk of sphincter lesions (first delivery with third\u2010degree laceration and\/or forceps) but no symptomatic anal incontinence.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>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).<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Anal incontinence at 6\u00a0months postpartum. Secondary outcomes were urinary incontinence, sexual morbidity, maternal and neonatal morbidities and worsening of external sphincter lesions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>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\u20138\u00a0weeks after delivery, there was no significant difference in anal continence between the two groups. At 6\u00a0months after delivery, median Vaizey scores of anal incontinence were 1 (interquartile range 0\u20134) in the CS group and 1 (interquartile range 0\u20133) in the VD group (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.34). There were no significant differences for urinary continence, sexual functions or for other maternal and neonatal morbidities.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In women with asymptomatic obstetric anal sphincter lesions diagnosed by ultrasound, planning a CS had no significant impact on anal continence 6\u00a0months after the second delivery. These results do not support advising systematic CS for this indication.<\/jats:p><\/jats:sec><jats:sec><jats:title>Tweetable abstract<\/jats:title><jats:p>Caesarean section for the second delivery did not protect against anal incontinence in women with asymptomatic obstetric anal sphincter lesions.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.16452","type":"journal-article","created":{"date-parts":[[2020,8,8]],"date-time":"2020-08-08T08:44:46Z","timestamp":1596876286000},"page":"685-693","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":32,"title":["Caesarean section in the second delivery to prevent anal incontinence after asymptomatic obstetric anal sphincter injury: the EPIC multicentre randomised trial"],"prefix":"10.1111","volume":"128","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5106-4317","authenticated-orcid":false,"given":"L","family":"Abramowitz","sequence":"first","affiliation":[{"name":"H\u00f4pital Bichat, Proctology Unit Department of Gastroenterology Assistance Publique\u2010H\u00f4pitaux de Paris Paris France"},{"name":"Ramsay g\u00e9n\u00e9ral de sant\u00e9, clinique Blomet Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5883-7597","authenticated-orcid":false,"given":"L","family":"Mandelbrot","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology H\u00f4pital Louis\u2010Mourier Assistance Publique\u2010H\u00f4pitaux de Paris Colombes France"},{"name":"Universit\u00e9 de Paris Paris France"},{"name":"Inserm IAME U1137 Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Bourgeois Moine","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology H\u00f4pital Bichat Assistance Publique\u2010H\u00f4pitaux de Paris Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"AL","family":"Tohic","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Centre Hospitalier de Versailles Le Chesnay France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C","family":"Carne Carnavalet","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology H\u00f4pital Armand Trousseau Assistance Publique\u2010H\u00f4pitaux de Paris Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"O","family":"Poujade","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Assistance Publique\u2010H\u00f4pitaux de Paris H\u00f4pital Beaujon Clichy France"},{"name":"Department of Obstetrics and Gynaecology H\u00f4pital des Rives de Seine Neuilly France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C","family":"Roy","sequence":"additional","affiliation":[{"name":"Unit\u00e9 de Recherche Clinique H\u00f4pital Bichat Assistance Publique\u2010H\u00f4pitaux de Paris Paris France"},{"name":"INSERM CIC\u2010EC 1425 Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F","family":"Tubach","sequence":"additional","affiliation":[{"name":"D\u00e9partement de Sant\u00e9 Publique INSERM Institut Pierre Louis d\u2019Epid\u00e9miologie et de Sant\u00e9 Publique AP\u2010HP H\u00f4pital Piti\u00e9\u2010Salp\u00eatri\u00e8re Sorbonne Universit\u00e9 Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,9,6]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2007.01502.x"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2005.10.796"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gyobfe.2016.05.007"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.10298"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2018.01.062"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.12363"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.4369"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1463-1318.2007.01445.x"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02235567"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2017.11.569"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1067\/S0002-9378(03)00621-5"},{"issue":"11","key":"e_1_2_6_13_1","first-page":"CD010374","article-title":"Interventions for women in subsequent pregnancies following obstetric anal sphincter injury to reduce the risk of recurrent injury and associated harms","volume":"6","author":"Farrar D","year":"2014","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2017.12.002"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000003041"},{"key":"e_1_2_6_16_1","unstructured":"RCOGRCoOaG.Management of third and fourth degree perineal tears. RCOG Press. 2015; Green top guideline 29."},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(09)61870-5"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jogoh.2018.12.002"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2015.12.030"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000266981.69332.db"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1136\/gut.44.1.77"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF01889235"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1080\/009262300278597"},{"key":"e_1_2_6_24_1","first-page":"56","article-title":"Elaboration and validation of a specific quality of life questionnaire for urination urgency in women","volume":"7","author":"Marquis P","year":"1997","journal-title":"Prog Urol"},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-199603000-00003"},{"key":"e_1_2_6_26_1","doi-asserted-by":"publisher","DOI":"10.1136\/gut.50.4.480"},{"key":"e_1_2_6_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2018.05.007"},{"key":"e_1_2_6_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0029-7844(97)00119-1"},{"key":"e_1_2_6_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)32002-6"},{"key":"e_1_2_6_30_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.18827"},{"key":"e_1_2_6_31_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006250-200005000-00002"},{"key":"e_1_2_6_32_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.7512"},{"key":"e_1_2_6_33_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0412.2010.01057.x"},{"key":"e_1_2_6_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2015.12.004"}],"container-title":["BJOG: An International Journal of Obstetrics &amp; Gynaecology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2F1471-0528.16452","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1471-0528.16452","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/1471-0528.16452","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1471-0528.16452","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,2]],"date-time":"2023-09-02T06:23:10Z","timestamp":1693635790000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1111\/1471-0528.16452"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,9,6]]},"references-count":33,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2021,3]]}},"alternative-id":["10.1111\/1471-0528.16452"],"URL":"https:\/\/doi.org\/10.1111\/1471-0528.16452","archive":["Portico"],"relation":{},"ISSN":["1470-0328","1471-0528"],"issn-type":[{"value":"1470-0328","type":"print"},{"value":"1471-0528","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,9,6]]},"assertion":[{"value":"2020-07-08","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-09-06","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}