{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T18:33:20Z","timestamp":1789238000130,"version":"build-2803163510"},"reference-count":38,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2015,2,24]],"date-time":"2015-02-24T00:00:00Z","timestamp":1424736000000},"content-version":"vor","delay-in-days":54,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Midwife Womens Health"],"published-print":{"date-parts":[[2015,1]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The aim of this study was to systematically review current evidence for the relationship between obstetric anal sphincter injury (ie, episiotomy and third\u2010 or fourth\u2010degree perineal lacerations) and anal incontinence in parous women.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      PubMed, Ovid (MEDLINE), Cochrane Trials, and Cumulative Index to Nursing and Allied Health Literature were searched. Studies eligible for review assessed the relationship between episiotomy and\/or third\u2010 or fourth\u2010degree perineal laceration and anal incontinence. Two reviewers independently searched for studies for review and used the Meta\u2010Analysis of Observational Studies in Epidemiology guidelines. Quality of individual studies was appraised using the Downs and Black criteria. Pooled effect sizes were estimated for the relationships between episiotomy and third\u2010 or fourth\u2010degree perineal laceration with anal incontinence using random effects meta\u2010analysis models. Heterogeneity of each model was assessed using Cochran Q and I\n                      <jats:sup>2<\/jats:sup>\n                      statistics.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 578 articles, 19 studies (7 prospective cohort studies, 6 retrospective studies, one case\u2010control study, and 5 population\u2010based cross\u2010sectional studies) met inclusion\/exclusion criteria for the systematic review. Of the 19 studies, 3 examined episiotomy, 7 examined third\u2010 or fourth\u2010degree perineal laceration, and 9 studies examined both risk factors for anal incontinence. Eight studies (N = 2929 women) examining the relationship between episiotomy and anal incontinence and 12 studies (N = 2288 women) examining the relationship between third\u2010 or fourth\u2010degree perineal laceration and anal incontinence met criteria for inclusion in the meta\u2010analyses. Pooled odds ratios (ORs) demonstrated a significant association between perineal trauma (episiotomy [OR, 1.74; 95% confidence interval [CI], 1.28\u20102.38; Q = 8.9;\n                      <jats:italic>P<\/jats:italic>\n                      &lt; .26; I\n                      <jats:sup>2<\/jats:sup>\n                      = 21.4] and third\u2010 or fourth\u2010degree perineal laceration (OR, 2.66; 95% CI, 1.77\u20103.98; Q = 27.9; P = .002; I\n                      <jats:sub>2<\/jats:sub>\n                      = 64.1) and anal incontinence.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Both episiotomy and third\u2010 or fourth\u2010degree perineal laceration are significantly associated with anal incontinence after vaginal birth. The evidence provided in this systematic review and meta\u2010analysis highlights the importance of reducing perineal trauma during vaginal births in order to ameliorate anal incontinence in parous women.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jmwh.12283","type":"journal-article","created":{"date-parts":[[2015,2,24]],"date-time":"2015-02-24T17:19:07Z","timestamp":1424798347000},"page":"37-47","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":138,"title":["Obstetric Anal Sphincter Injury and Anal Incontinence Following Vaginal Birth: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1111","volume":"60","author":[{"given":"Allison","family":"LaCross","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meredith","family":"Groff","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arlene","family":"Smaldone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2015,2,24]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-009-0976-9"},{"key":"e_1_2_7_3_1","unstructured":"National Digestive Diseases Information Clearinghouse. Fecal Incontinence.2012; NIH Publication No. 13\u20104866.http:\/\/digestive.niddk.nih.gov\/ddiseases\/pubs\/fecalincontinence\/#4. Accessed November 27 2012."},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/GCO.0b013e3282ef4142"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1080\/01443610310001604358"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.293.17.2141"},{"issue":"4","key":"e_1_2_7_7_1","first-page":"957","article-title":"ACOG Practice Bulletin. Episiotomy. Clinical Management Guidelines for Obstetrician\u2010Gynecologists. Number 71, April 2006","volume":"107","author":"American College of Obstetricians\u2010Gynecologists","year":"2006","journal-title":"Obstet Gynecol."},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e318240df4f"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.283.15.2008"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1136\/jech.52.6.377"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9378(99)70370-4"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2003.09.030"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1701-2163(16)34051-8"},{"issue":"3","key":"e_1_2_7_14_1","first-page":"326","article-title":"Anal incontinence after childbirth","volume":"166","author":"Eason E","year":"2002","journal-title":"CMAJ"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2001.00183.x"},{"key":"e_1_2_7_16_1","volume-title":"Chapter 9: Analysing data and undertaking meta\u2010analyses","author":"Deeks JJ","year":"2011"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000119223.04441.c9"},{"issue":"3","key":"e_1_2_7_18_1","first-page":"232","article-title":"Factors associated with postpartum urinary\/anal incontinence in primiparous women in Quebec","volume":"29","author":"Hatem M","year":"2007","journal-title":"J"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.320.7227.86"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0412.2010.01057.x"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2004.11.031"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2011.10.010"},{"issue":"9","key":"e_1_2_7_23_1","doi-asserted-by":"crossref","first-page":"830","DOI":"10.1034\/j.1600-0412.2001.080009830.x","article-title":"Anal sphincter damage after vaginal delivery: functional outcome and risk factors for fecal incontinence","volume":"80","author":"Leeuw JW","year":"2001","journal-title":"Acta Obstet Gynecol Scand"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0412.2012.01398.x"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02235567"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1067\/mob.2003.333"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1463-1318.2007.01445.x"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.1080\/00365529950173753"},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000232504.32589.3b"},{"key":"e_1_2_7_30_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.1187"},{"key":"e_1_2_7_31_1","doi-asserted-by":"publisher","DOI":"10.1002\/0470870168"},{"issue":"1","key":"e_1_2_7_32_1","first-page":"1","article-title":"NIH state\u2010of\u2010the\u2010science conference statement on prevention of fecal and urinary incontinence in adults","volume":"24","author":"National Institute of Health","year":"2007","journal-title":"NIH Consens State Sci Statements"},{"key":"e_1_2_7_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2004.11.017"},{"key":"e_1_2_7_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2008.11.022"},{"issue":"92","key":"e_1_2_7_35_1","first-page":"56","article-title":"Disturbing \u201cnew\u201d trends in tear prevention threaten midwives\u2019 autonomy","author":"Greve T","year":"2009","journal-title":"Midwifery Today Int Midwife"},{"key":"e_1_2_7_36_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD006672.pub2"},{"key":"e_1_2_7_37_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.c3414"},{"issue":"3","key":"e_1_2_7_38_1","first-page":"CD002866","article-title":"Methods of repair for obstetric anal sphincter injury","author":"Fernando R","year":"2006","journal-title":"Cochrane Database Syst Rev."},{"key":"e_1_2_7_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmwh.2005.10.014"}],"container-title":["Journal of Midwifery &amp; Women's Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fjmwh.12283","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fjmwh.12283","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jmwh.12283","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,6,7]],"date-time":"2024-06-07T07:32:26Z","timestamp":1717745546000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jmwh.12283"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,1]]},"references-count":38,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2015,1]]}},"alternative-id":["10.1111\/jmwh.12283"],"URL":"https:\/\/doi.org\/10.1111\/jmwh.12283","archive":["Portico"],"relation":{},"ISSN":["1526-9523","1542-2011"],"issn-type":[{"value":"1526-9523","type":"print"},{"value":"1542-2011","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,1]]},"assertion":[{"value":"2015-02-24","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}