Asian-white Disparities in Obstetric Anal Sphincter Injury: Protocol for a Systematic Review and Meta-analysis

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2023 Sep 8

PMID 37682913

Authors

Meejin Park

Susitha Wanigaratne

Rohan DSouza

Roxana Geoffrion

Sarah A Williams

Giulia M Muraca

Affiliations

Soon will be listed here.

Abstract

Background: Obstetric anal sphincter injury (OASI) describes severe injury to the perineum and perineum and perianal muscles following birth and occurs in 4.4% to 6.0% of vaginal births in Canada. Studies from high-income countries have identified an increased risk of OASI in individuals who identify as Asian race versus those who identify as white. This protocol outlines a systematic review and meta-analysis which aims to determine the incidence of OASI in individuals living in high-income countries who identify as Asian versus those of white race/ethnicity. We hypothesize that the pooled incidence of OASI will be higher in Asian versus white birthing individuals.

Methods: We will search MEDLINE, OVID, Embase, Emcare and Cochrane databases from inception to 2022 for observational studies using keywords and controlled vocabulary terms related to race, ethnicity and OASI. Two reviewers will follow the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines and Meta-analysis of Observational Studies (MOOSE) recommendations. Meta-analysis will be performed using RevMan for dichotomous data using the random effects model and the odds ratio (OR) as effect measure with a 95% confidence interval (CI). Subgroup analysis will be performed based on Asian subgroups (e.g., South Asian, Filipino, Chinese, Japanese individuals). Study quality assessment will be performed using The Joanna Briggs Institute Critical Appraisal tools.

Discussion: The systematic review and meta-analysis that this protocol outlines will synthesize the extant literature to better estimate the rates of OASI in Asian and white populations in non-Asian, high-income settings and the relative risk of OASI between these two groups. This systematic summary of the evidence will inform the discrepancy in health outcomes experienced by Asian and white birthing individuals. If these findings suggest a disproportionate burden among Asians, they will be used to advocate for future studies to explore the causal mechanisms underlying this relationship, such as differential care provision, barriers to accessing care, and social and institutional racism. Ultimately, the findings of this review can be used to frame obstetric care guidelines and inform healthcare practices to ensure care that is equitable and accessible to diverse populations.

Citing Articles

Asian-White disparities in obstetric anal sphincter injury: a systematic review and meta-analysis.

Park M, Wanigaratne S, DSouza R, Geoffrion R, Williams S, Muraca G AJOG Glob Rep. 2024; 4(1):100296.

PMID: 38283323 PMC: 10820309. DOI: 10.1016/j.xagr.2023.100296.

References

Liberati A, Altman D, Tetzlaff J, Mulrow C, Gotzsche P, Ioannidis J . The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009; 339:b2700. PMC: 2714672. DOI: 10.1136/bmj.b2700. View

Handa V, Blomquist J, McDermott K, Friedman S, Munoz A . Pelvic floor disorders after vaginal birth: effect of episiotomy, perineal laceration, and operative birth. Obstet Gynecol. 2012; 119(2 Pt 1):233-9. PMC: 3266992. DOI: 10.1097/AOG.0b013e318240df4f. View

Shah N, Kandula N . Addressing Asian American Misrepresentation and Underrepresentation in Research. Ethn Dis. 2020; 30(3):513-516. PMC: 7360176. DOI: 10.18865/ed.30.3.513. View

BYRD W, Clayton L . Race, medicine, and health care in the United States: a historical survey. J Natl Med Assoc. 2003; 93(3 Suppl):11S-34S. PMC: 2593958. View

Wegnelius G, Hammarstrom M . Complete rupture of anal sphincter in primiparas: long-term effects and subsequent delivery. Acta Obstet Gynecol Scand. 2011; 90(3):258-63. DOI: 10.1111/j.1600-0412.2010.01037.x. View

Sorbye I, Bains S, Vangen S, Sundby J, Lindskog B, Owe K . Obstetric anal sphincter injury by maternal origin and length of residence: a nationwide cohort study. BJOG. 2021; 129(3):423-431. DOI: 10.1111/1471-0528.16985. View

Gurol-Urganci I, Cromwell D, Edozien L, Mahmood T, Adams E, Richmond D . Third- and fourth-degree perineal tears among primiparous women in England between 2000 and 2012: time trends and risk factors. BJOG. 2013; 120(12):1516-25. DOI: 10.1111/1471-0528.12363. View

Baghestan E, Irgens L, Bordahl P, Rasmussen S . Trends in risk factors for obstetric anal sphincter injuries in Norway. Obstet Gynecol. 2010; 116(1):25-34. DOI: 10.1097/AOG.0b013e3181e2f50b. View

Goldberg J, Hyslop T, Tolosa J, Sultana C . Racial differences in severe perineal lacerations after vaginal delivery. Am J Obstet Gynecol. 2003; 188(4):1063-7. DOI: 10.1067/mob.2003.251. View

10.

Tung C, Cheon W, Tong W, Leung H . Incidence and Risk Factors of Obstetric Anal Sphincter Injuries after Various Modes of Vaginal Deliveries in Chinese Women. Chin Med J (Engl). 2015; 128(18):2420-5. PMC: 4725569. DOI: 10.4103/0366-6999.164874. View

11.

Lu C, Ahmed R, Lamri A, Anand S . Use of race, ethnicity, and ancestry data in health research. PLOS Glob Public Health. 2023; 2(9):e0001060. PMC: 10022242. DOI: 10.1371/journal.pgph.0001060. View

12.

Tilak M, Mann G, Gong M, Koenig N, Lee T, Geoffrion R . Pelvic floor healing milestones after obstetric anal sphincter injury: a prospective case control feasibility study. Int Urogynecol J. 2022; 34(2):553-561. PMC: 9469830. DOI: 10.1007/s00192-022-05348-6. View

13.

Ampt A, Patterson J, Roberts C, Ford J . Obstetric anal sphincter injury rates among primiparous women with different modes of vaginal delivery. Int J Gynaecol Obstet. 2015; 131(3):260-4. DOI: 10.1016/j.ijgo.2015.06.025. View

14.

Holdt Somer S, Sinkey R, Bryant A . Epidemiology of racial/ethnic disparities in severe maternal morbidity and mortality. Semin Perinatol. 2017; 41(5):258-265. DOI: 10.1053/j.semperi.2017.04.001. View

15.

Gurol-Urganci I, Bidwell P, Sevdalis N, Silverton L, Novis V, Freeman R . Impact of a quality improvement project to reduce the rate of obstetric anal sphincter injury: a multicentre study with a stepped-wedge design. BJOG. 2021; 128(3):584-592. PMC: 7818460. DOI: 10.1111/1471-0528.16396. View

16.

Witherspoon D, Wooding S, Rogers A, Marchani E, Watkins W, Batzer M . Genetic similarities within and between human populations. Genetics. 2007; 176(1):351-9. PMC: 1893020. DOI: 10.1534/genetics.106.067355. View

17.

Hauck Y, Lewis L, Nathan E, White C, Doherty D . Risk factors for severe perineal trauma during vaginal childbirth: a Western Australian retrospective cohort study. Women Birth. 2014; 28(1):16-20. DOI: 10.1016/j.wombi.2014.10.007. View

18.

Hobson S, Cassell K, Windrim R, Cargill Y . No. 381-Assisted Vaginal Birth. J Obstet Gynaecol Can. 2019; 41(6):870-882. DOI: 10.1016/j.jogc.2018.10.020. View

19.

Ross P, Hart-Johnson T, Santen S, Bibler Zaidi N . Considerations for using race and ethnicity as quantitative variables in medical education research. Perspect Med Educ. 2020; 9(5):318-323. PMC: 7550522. DOI: 10.1007/s40037-020-00602-3. View

20.

Guendelman S, Thornton D, Gould J, Hosang N . Obstetric complications during labor and delivery: assessing ethnic differences in California. Womens Health Issues. 2006; 16(4):189-97. DOI: 10.1016/j.whi.2005.12.004. View