{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T02:04:21Z","timestamp":1783735461023,"version":"3.55.0"},"reference-count":28,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2022,6,15]],"date-time":"2022-06-15T00:00:00Z","timestamp":1655251200000},"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":[[2022,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>There is increased focus on obstetric anal sphincter injury (OASI) and there are several well\u2010established risk factors such as birthweight, instrumental delivery and median episiotomy. Some studies have found increased risk of OASI in women delivering vaginally after a previous caesarean section (VBAC).<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To evaluate whether there is increased prevalence of OASI in VBAC compared with primiparous women.<\/jats:p><\/jats:sec><jats:sec><jats:title>Search strategy<\/jats:title><jats:p>Literature search using PubMed, Embase and Cochrane databases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Selection criteria<\/jats:title><jats:p>All studies with data on both primiparous women and women undergoing VBAC were included. All included studies were evaluated using the \u201cSIGN\u00a0\u2013\u00a0methodology checklist\u201d to verify if the quality was acceptable.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data collection and analysis<\/jats:title><jats:p>This systematic review included 23 articles conducted in 11 countries over 19\u2009years. Included studies were analysed using <jats:sc>RevMan<\/jats:sc> version 5.4.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main results<\/jats:title><jats:p>We found increased prevalence of OASI in the VBAC group; 8.18% (95% confidence interval [CI] 8.07\u20138.29) compared with 6.59% (95% CI 6.56\u20136.62) in primiparous women. Correspondingly, the meta\u2010analysis revealed increased prevalence for OASI in the VBAC group (odds ratio 1.27, 95% CI 1.10\u20131.47). We found a high level of heterogeneity (<jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u00a0=\u200998%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Women undergoing VBAC had a higher prevalence of OASI compared with primiparous women.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.17227","type":"journal-article","created":{"date-parts":[[2022,5,21]],"date-time":"2022-05-21T11:54:00Z","timestamp":1653134040000},"page":"1961-1968","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Increased risk of obstetric anal sphincter injury in women undergoing vaginal delivery after caesarean section: A systematic review and meta\u2010analysis"],"prefix":"10.1111","volume":"129","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5201-8171","authenticated-orcid":false,"given":"Kathrine","family":"Perslev","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynaecology Herlev University Hospital  Herlev Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ella\u2010Josephine","family":"M\u00f8rch","sequence":"additional","affiliation":[{"name":"Faculty of Health and Medical Science University of Copenhagen  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanna","family":"Jang\u00f6","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Herlev University Hospital  Herlev Denmark"},{"name":"Faculty of Health and Medical Science University of Copenhagen  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,6,15]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192\u2010019\u201003978\u2010x"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192\u2010012\u20102006\u20106"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.12706"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2019.02.004"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1067\/mob.2002.126977"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192\u2010018\u20103797\u2010x"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-019-2359-7"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajo.12839"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e3181e2f50b"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2006.10.893"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.midw.2015.11.004"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2011.06.035"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.13526"},{"issue":"1","key":"e_1_2_9_15_1","first-page":"306","article-title":"Risk of obstetric anal sphincter injury increases with maternal age irrespective of parity: a population\u2010based register study","volume":"17","author":"Waldenstr\u00f6m U","year":"2017","journal-title":"BMC"},{"key":"e_1_2_9_16_1","article-title":"Risk of obstetric anal sphincter injury among women who birth vaginally after a prior caesarean section: a state\u2010wide cohort study","author":"Uebergang J","year":"2021","journal-title":"BJOG An Int J Obstet Gynaecol"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.wombi.2018.12.006"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00404-020-05443-3"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000002444"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.190366"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2021.03.006"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jogoh.2019.07.004"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.13977"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006250-200108000-00008"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0412.2011.01263.x"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-015-0689-7"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.m3377"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.14244"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000134784.09455.21"}],"container-title":["BJOG: An International Journal of Obstetrics &amp; 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