{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T14:36:32Z","timestamp":1787841392085,"version":"build-2784847793"},"reference-count":25,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2023,3,17]],"date-time":"2023-03-17T00:00:00Z","timestamp":1679011200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Gynecology & Obste"],"published-print":{"date-parts":[[2023,8]]},"abstract":"Abstract<\/jats:title>Objective<\/jats:title>To assess the association between episiotomy and severe obstetric anal sphincter injury (OASIS) in nulliparous women at term according to the use of an instrument for delivery with control confounding by indication.<\/jats:p><\/jats:sec>Methods<\/jats:title>This was an observational retrospective cohort study including 12\u2009346 women from 2004 to 2020. All nulliparous women with a cephalic singleton pregnancy were included. The primary outcome was the occurrence of OASIS. Association between episiotomy and OASIS was assessed by multivariate logistic regression with adjustment for confounding factors and stratification on the use of an instrument at delivery. Propensity score matching was used to account for indication bias.<\/jats:p><\/jats:sec>Results<\/jats:title>Among 12\u2009346 women included, 7803 (63.2%) had an episiotomy and 4543 (36.8%) did not have an episiotomy; the rate of OASIS was similar in both groups (0.7%). After stratification on use of instrument, an association between episiotomy and OASIS was shown in the case of instrumental delivery (odds ratio [OR] 0.46, 95% confidence interval [CI] 0.26\u20130.80) but not if the delivery was spontaneous (OR 0.76, 95% CI 0.29\u20131.98). The result was similar after matching on propensity score (in the case of operative vaginal delivery: OR 0.20, 95% CI 0.10\u20130.75).<\/jats:p><\/jats:sec>Conclusion<\/jats:title>Episiotomy seems to be a protective factor for OASIS in nulliparous woman at term only in the case of operative vaginal delivery.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ijgo.14706","type":"journal-article","created":{"date-parts":[[2023,2,2]],"date-time":"2023-02-02T14:06:12Z","timestamp":1675346772000},"page":"632-638","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Effectiveness of episiotomy to prevent OASIS<\/scp> in nulliparous women at term"],"prefix":"10.1002","volume":"162","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0958-8926","authenticated-orcid":false,"given":"Antoine","family":"Perrin","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Robert Debr\u00e9 Hospital, APHP Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diane","family":"Korb","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Robert Debr\u00e9 Hospital, APHP Paris France"},{"name":"Center for Epidemiology and Statistics Sorbonne Paris Cit\u00e9 (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team EPOP\u00e9, INSERM, INRA, University Paris Cit\u00e9 Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosemary","family":"Morgan","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Robert Debr\u00e9 Hospital, APHP Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivier","family":"Sibony","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Robert Debr\u00e9 Hospital, APHP Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,3,17]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2007.01502.x"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.12894"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2013.01.027"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2014.08.031"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006254-199511000-00021"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gofs.2018.10.029"},{"key":"e_1_2_8_8_1","unstructured":"Third\u2010 and Fourth\u2010degree Perineal Tears Management (Green\u2010top Guideline No. 29). 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