Does mediolateral or lateral episiotomy reduce the risk of anal incontinence in primiparous women undergoing an operative vaginal delivery? A systematic review and meta-analysis protocol
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Background: Obstetric anal sphincter injuries are the leading cause of anal incontinence. Primiparous women undergoing assisted vaginal deliveries are at the greatest risk of experiencing these injuries. Mediolateral or lateral episiotomy has been identified as a potential intervention to reduce this risk. However, anal incontinence, the more clinically significant outcome, requires further exploration. The aim of this systematic review is to evaluate whether mediolateral/lateral episiotomy in primiparous women undergoing assisted vaginal delivery reduces the incidence of anal incontinence, and to determine the corresponding number-needed-to-treat (NNT). Methods: A systematic search of the literature will be conducted in the following information sources: PubMed, The Cochrane Library, EMBASE, Google Scholar and the references list of eligible articles. Articles will be screened against the inclusion and exclusion criteria at the level of the title, abstract and full text. Full-text articles that meet the inclusion criteria will then be assessed independently by two investigators. A sensitivity analyses will be performed. If enough studies report relevant data and the heterogeneity index (I²) is <75%, a meta-analysis will be conducted; otherwise, only a descriptive synthesis will be provided. Risk of bias will be assessed using validated tools, and the overall quality of evidence will be evaluated. PROSPERO registration number: CRD420251076735
