How to advise women with a medical history of surgically corrected anorectal malformation on vaginal delivery: a systematic review

Objective: Discussion remains on how to advise women with a past medical history of surgically corrected anorectal malformations (ARMs) regarding vaginal delivery. The aim of this review is to evaluate and review the reported obstetrical complications and outcomes after vaginal delivery for these women. Data sources A systematic search was performed from inception up to 8 December 2020 in PubMed, Embase.com and Clarivate Analytics/Web of Science Core Collection, with backward citation tracking. Study eligibility criteria / appraisal All articles reported on the outcomes of interest in women with a past medical history of surgically corrected anorectal malformation and had a vaginal delivery were included with the exception of editorial comments or invitational commentaries. Screening and data extraction was done by two authors independently with a third and fourth reviewer in case of disagreement. Tool for Quality assessment depended on the type of article. As low quality evidence was expected no meta-analysis was performed. Results: Only four of the 2125 articles screened were eligible for inclusion with a total of 12 vaginal deliveries attempts in 7 women. In two patients complications were reported: failed vaginal delivery requiring urgent cesarean section (n=1), vaginal tears (n=1). Conclusion: high quality evidence regarding outcomes and complications after vaginal delivery in women with a history of surgically corrected anorectal malformation is lacking. Therefore, based upon this systematic review no formal recommendation can be formulated regarding its safety. Future studies are essential to address this problem. Prospero registration: CRD42020201390. Date: 28-07-2020s