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Subgroups: short\u2010term AI, long\u2010term 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\u2010 to post\u2010 subsequent birth.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Results<\/jats:title><jats:p>There was no evidence of a difference in adjusted AI after subsequent vaginal birth compared with CS after OASI across all time periods (OR\u2009=\u20090.92, 95% CI 0.72\u20131.20; 9 studies, 2104 participants, <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u2009=\u20090% <jats:italic>p<\/jats:italic>\u2009=\u20090.58), for subgroup analyses or secondary outcomes. There was no evidence of a difference in AI in women with or without subsequent birth (OR\u2009=\u20091.00 95% CI 0.65\u20131.54; 10 studies, 970 participants, <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u2009=\u200935% <jats:italic>p<\/jats:italic>\u2009=\u20090.99), or pre\u2010 to post\u2010 subsequent birth (OR\u2009=\u20090.79 95% CI 0.51\u20131.25; 13 studies, 5496 participants, <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u2009=\u200973% <jats:italic>p<\/jats:italic>\u2009=\u20090.31).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Due 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\u2010making for asymptomatic women and to determine the effect of subsequent birth mode on long\u2010term AI outcomes.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.17899","type":"journal-article","created":{"date-parts":[[2024,7,5]],"date-time":"2024-07-05T05:39:41Z","timestamp":1720157981000},"page":"1032-1044","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Caesarean section and anal incontinence in women after obstetric anal sphincter injury: A systematic review and meta\u2010analysis"],"prefix":"10.1111","volume":"132","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6336-7916","authenticated-orcid":false,"given":"Emily","family":"Carter","sequence":"first","affiliation":[{"name":"The Warrell Unit, Saint Mary's Hospital, Manchester University NHS Foundation Trust Manchester Academic Health Science Centre  Manchester 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