{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T22:13:05Z","timestamp":1779919985130,"version":"3.53.1"},"reference-count":38,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,6,30]],"date-time":"2025-06-30T00:00:00Z","timestamp":1751241600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pregnancy"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Operative vaginal delivery (OVD) has experienced a decline, primarily driven by decreasing rates of forceps\u2010assisted vaginal delivery (FAVD). FAVD rates have been suspected to be declining to a point where recovery of this skill may be improbable. While there are numerous reasons for this decline, ranging from lack of training to patient preferences, the same period has been suspected to have worsening morbidity with FAVD. Concerns have been raised with respect to obstetric anal sphincter injuries (OASIS). This study aims to characterize national trends in OVD and risk factors for associated OASIS between 2016 and 2023 by assessing changes in OVD utilization and the associated risk of OASIS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and Methods<\/jats:title><jats:p>This is a cross\u2010sectional study using National Vital Statistics System birth certificate data between 2016 and 2023 to identify temporal trends in OVD and OASIS rates. Liveborn deliveries undergoing trial of labor from 34\u00a0weeks and 0 days to 42\u00a0weeks and 6 days to patients aged 16\u201350 years were included. Pregnancies with multifetal gestations, fetal anomalies, non\u2010vertex presentations, and unknown mode of delivery were excluded. Temporal trends in OVD and OASIS were assessed using Joinpoint regression. Multivariable logistic regression models were fit to assess the association between OASIS and OVD, adjusting for maternal demographics and comorbidities.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 21,191,398 liveborn deliveries identified, 18,054,141 (85.2%) were spontaneous vaginal births, 2,303,168 (10.9%) were cesarean after trial of labor, 136,927 (0.6%) were FAVDs, and 697,162 (3.3%) were vacuum\u2010assisted vaginal deliveries (VAVDs) with a OVD composite of 3.9%. OVD rates decreased significantly from 4.6% to 4.1% (annual average percent change [AAPC]: \u22121.6%, 95% CI: \u22121.9% to \u22121.4%). Specifically, FAVD rates declined from 0.8% to 0.6% (AAPC: \u22123.1%, 95% CI: \u22123.7% to \u22122.6%) and VAVD rates declined from 3.8% to 3.4% (AAPC: \u22121.4%, 95%CI: \u22121.7% to 1.1%). OASIS rates in the overall group did not significantly change (AAPC: 1.4%, 95%CI: \u22122.1% to 4.4%), although among FAVDs, there was a significant increase in rates of OASIS from 9.3% in 2016 to 14.0% in 2023 (AAPC: 4.8%, 95%CI: 2.3% to 7.0%). Adjusted multivariable logistic regression noted higher likelihood of OASIS in FAVD (aOR: 9.50, 95%CI: 9.33 to 9.66), and VAVD (aOR: 3.90, 95%CI: 3.85 to 3.94) when compared to spontaneous vaginal birth, adjusting for maternal age, maternal BMI, and maternal comorbidities including diabetes and hypertensive disorders.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The primary finding in this study was a national decline in OVD with significantly greater declines in FAVD and an increasing rate of OASIS among FAVD. Whether targeted interventions to enhance training in safe FAVD may increase proficiency in this technique remains to be seen.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pmf2.70063","type":"journal-article","created":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T01:00:36Z","timestamp":1751331636000},"source":"Crossref","is-referenced-by-count":2,"title":["Contemporary trends in operative vaginal delivery and obstetric anal sphincter injuries from 2016 to 2023"],"prefix":"10.1002","volume":"1","author":[{"given":"Minhazur R.","family":"Sarker","sequence":"first","affiliation":[{"name":"Department of Obstetrics Gynecology and Reproductive Science University of California San Diego  San Diego California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth N.","family":"Teal","sequence":"additional","affiliation":[{"name":"Department of Obstetrics Gynecology and Reproductive Science University of California San Diego  San Diego California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Wiley","sequence":"additional","affiliation":[{"name":"Department of Obstetrics Gynecology and Reproductive Science University of California San Diego  San Diego California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ukachi","family":"Emeruwa","sequence":"additional","affiliation":[{"name":"Department of Obstetrics Gynecology and Reproductive Science University of California San Diego  San Diego California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joyce","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Obstetrics Gynecology and Reproductive Science Mount Sinai Health System &amp; Icahn School of Medicine at Mount Sinai  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Arida","sequence":"additional","affiliation":[{"name":"Department of Obstetrics Gynecology and Reproductive Science Mount Sinai Health System &amp; Icahn School of Medicine at Mount Sinai  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Engelbert","sequence":"additional","affiliation":[{"name":"Department of Obstetrics Gynecology and Reproductive Science Mount Sinai Health System &amp; Icahn School of Medicine at Mount Sinai  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cynthia","family":"Gyamfi\u2010Bannerman","sequence":"additional","affiliation":[{"name":"Department of Obstetrics Gynecology and Reproductive Science University of California San Diego  San Diego California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy","family":"Wen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics Gynecology and Reproductive Science University of California San Diego  San Diego California USA"},{"name":"Department of Medicine University of California San Diego  San Diego California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,6,30]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000001557"},{"issue":"1","key":"e_1_2_9_3_1","first-page":"1","article-title":"Births: Final Data for 2013","volume":"64","author":"Martin J. 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