{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T18:54:08Z","timestamp":1780512848168,"version":"3.54.1"},"reference-count":35,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T00:00:00Z","timestamp":1758844800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T00:00:00Z","timestamp":1758844800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Gynecology &amp; Obste"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Episiotomy and obstetric anal sphincter injuries (OASIS) are recognized indicators of intrapartum care quality. The aim of this study was to assess episiotomy trends in non\u2010instrumental vaginal deliveries across all Portuguese public maternities over the last decade. Rates of third\u2010 and fourth\u2010degree perineal lacerations were also evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective secondary data analysis was conducted using data from an official national health entity, including all non\u2010instrumental vaginal deliveries in the Portuguese National Health Service between January 1, 2013 and December 31, 2022. Information on episiotomy and third\u2010 and fourth\u2010degree perineal lacerations was extracted. Descriptive statistics were presented using absolute and relative frequencies. Linear regression was used to assess trends. Additional national databases were consulted to validate findings, and data quality was assessed using the intraclass correlation coefficient (ICC). A significance level of 5% was considered.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 689\u2009908 registered deliveries, 490\u2009322 (71%) were vaginal, and 361\u2009887 (52%) were non\u2010instrumental vaginal deliveries. Among the latter, the episiotomy rate was 42.5%. A significant decrease was observed in episiotomy rates, from 63% in 2013 to 21% in 2022, (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001), accompanied by a significant increase in third\u2010degree perineal lacerations (0.15% to 0.31%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001), while fourth\u2010degree perineal lacerations remained stable (0.03% to 0.02%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A restrictive episiotomy policy was increasingly adopted in Portugal over the last decade. Although rare, third\u2010degree perineal lacerations increased during this period. Further research is needed to determine optimal intrapartum care practices regarding episiotomy use. Standardized data coding and improved access to anonymized national datasets are essential for accurate monitoring and cross\u2010country comparability.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ijgo.70564","type":"journal-article","created":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T11:22:31Z","timestamp":1758885751000},"page":"1684-1690","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["National trends of episiotomy in non\u2010instrumental vaginal deliveries (2013\u20132022): A multi\u2010data source approach"],"prefix":"10.1002","volume":"172","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-1834-8193","authenticated-orcid":false,"given":"Mariana","family":"Bandeira","sequence":"first","affiliation":[{"name":"Faculty of Medicine University of Porto  Porto Portugal"},{"name":"Department of Gynecology\u2010Obstetrics Unidade Local de Sa\u00fade do Alto Minho (ULSAM)  Viana do Castelo Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7109-1101","authenticated-orcid":false,"given":"Cristina","family":"Costa\u2010Santos","sequence":"additional","affiliation":[{"name":"CINTESIS@RISE, Faculty of Medicine University of Porto  Porto Portugal"},{"name":"MEDCIDS\u2014Department of Community Medicine, Health Information and Decision, Faculty of Medicine University of Porto  Porto Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2278-2264","authenticated-orcid":false,"given":"Fernando","family":"Lopes","sequence":"additional","affiliation":[{"name":"CINTESIS@RISE, Faculty of Medicine University of Porto  Porto Portugal"},{"name":"MEDCIDS\u2014Department of Community Medicine, Health Information and Decision, Faculty of Medicine University of Porto  Porto Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4321-2217","authenticated-orcid":false,"given":"Jo\u00e3o","family":"Bernardes","sequence":"additional","affiliation":[{"name":"CINTESIS@RISE, Faculty of Medicine University of Porto  Porto Portugal"},{"name":"Department of Gynecology\u2010Obstetrics and Pediatrics, Faculty of Medicine University of Porto  Porto Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6768-5716","authenticated-orcid":false,"given":"Ana","family":"Reynolds","sequence":"additional","affiliation":[{"name":"CINTESIS@RISE, Faculty of Medicine University of Porto  Porto Portugal"},{"name":"Department of Gynecology\u2010Obstetrics and Pediatrics, Faculty of Medicine University of Porto  Porto Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,9,26]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1080\/07399332.2018.1445253"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.3109\/01443615.2015.1065233"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-017-3480-7"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1080\/14767058.2021.2005022"},{"key":"e_1_2_11_6_1","article-title":"Selective versus routine use of episiotomy for vaginal birth","volume":"2","author":"Jiang H","year":"2017","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.12856"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000002841"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2017.04.006"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-016-2956-1"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12978-016-0242-9"},{"key":"e_1_2_11_12_1","unstructured":"WHO recommendations: intrapartum care for a positive childbirth experience. 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