{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T02:18:38Z","timestamp":1793931518089,"version":"4.8.0"},"reference-count":25,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,10,6]],"date-time":"2025-10-06T00:00:00Z","timestamp":1759708800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2025,10,6]],"date-time":"2025-10-06T00:00:00Z","timestamp":1759708800000},"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":[[2026,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To determine the association between epidural analgesia and perineal injury, including obstetric anal sphincter injury (OASI), in primiparous women.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study of primiparous women with singleton, term, vertex, and vaginal deliveries between 2012 and 2024 at a tertiary medical center. Primary outcomes were (1) any perineal injury, and (2) OASI. Propensity score matching (1:1) was used to adjust for maternal and obstetric confounders. Perineal outcomes were compared in matched and unmatched cohorts using standardized mean difference (SMD). An SMD &lt;0.1 was considered negligible, 0.1\u20130.2 small, and &gt;0.2 clinically significant. Multivariable logistic regression was used to evaluate associations between epidural use and outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Overall, 45\u2009132 women were included, of whom 36\u2009799 (81.5%) received epidural analgesia. After matching (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20095974 per group), baseline characteristics were balanced apart from fetal head station at full dilation, which was higher in the no\u2010epidural group (0.90\u2009\u00b1\u20090.9 vs. 0.66\u2009\u00b1\u20090.8; SMD\u2009=\u20090.239). Perineal injury occurred more often with epidural with a marginal difference (82.2% vs. 78.2%, SMD\u2009=\u20090.10). In a multivariable logistic regression analysis, epidural was associated with more perineal injury only in the absence of episiotomy (adjusted odds ratio [aOR] 1.321; 95% confidence interval [CI]: 1.225\u20131.425;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001), but not when episiotomy was performed. Conversely, epidural use was associated with lower OASI risk regardless of whether episiotomy was performed (aOR 0.492; 95% CI: 0.285\u20130.849;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.011) or not (aOR 0.592; 95% CI: 0.424\u20130.825;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.002).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In primiparous term vaginal deliveries, epidural analgesia modestly increased low\u2010grade perineal tears but reduced OASI risk, supporting its safety regarding severe perineal trauma.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ijgo.70578","type":"journal-article","created":{"date-parts":[[2025,10,6]],"date-time":"2025-10-06T23:28:31Z","timestamp":1759793311000},"page":"144-150","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["The association between epidural analgesia and perineal injury in primiparous women: A propensity score\u2010matched cohort study"],"prefix":"10.1002","volume":"173","author":[{"given":"Omri","family":"Dominsky","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Lis Hospital for Women's Health Tel Aviv Sourasky Medical Center  Tel Aviv Israel"},{"name":"Gray Faculty of Medical and Health Sciences Tel Aviv University  Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanuel","family":"Attali","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Lis Hospital for Women's Health Tel Aviv Sourasky Medical Center  Tel Aviv Israel"},{"name":"Gray Faculty of Medical and Health Sciences Tel Aviv University  Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uri","family":"Amikam","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Lis Hospital for Women's Health Tel Aviv Sourasky Medical Center  Tel Aviv Israel"},{"name":"Gray Faculty of Medical and Health Sciences Tel Aviv University  Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronen","family":"Gold","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Lis Hospital for Women's Health Tel Aviv Sourasky Medical Center  Tel Aviv Israel"},{"name":"Gray Faculty of Medical and Health Sciences Tel Aviv University  Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chaim","family":"Greenberger","sequence":"additional","affiliation":[{"name":"Gray Faculty of Medical and Health Sciences Tel Aviv University  Israel"},{"name":"Division of Anesthesia, Critical Care and Pain Tel Aviv Sourasky Medical Center  Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yariv","family":"Yogev","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Lis Hospital for Women's Health Tel Aviv Sourasky Medical Center  Tel Aviv Israel"},{"name":"Gray Faculty of Medical and Health Sciences Tel Aviv University  Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoav","family":"Baruch","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Lis Hospital for Women's Health Tel Aviv Sourasky Medical Center  Tel Aviv Israel"},{"name":"Gray Faculty of Medical and Health Sciences Tel Aviv University  Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,10,6]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2022.06.021"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199312233292601"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2000.tb11689.x"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2004.02.064"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2648.2010.05428.x"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-014-2406-x"},{"key":"e_1_2_9_8_1","unstructured":"Royal College of Obstetricians and Gynaecologists.The Management of Third\u2010 and Fourth\u2010Degree Perineal Tears. 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