{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T17:01:24Z","timestamp":1792429284250,"version":"4.5.0"},"reference-count":61,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2023,10,3]],"date-time":"2023-10-03T00:00:00Z","timestamp":1696291200000},"content-version":"vor","delay-in-days":2,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100003130","name":"Fonds Wetenschappelijk Onderzoek","doi-asserted-by":"publisher","award":["1S49923N"],"award-info":[{"award-number":["1S49923N"]}],"id":[{"id":"10.13039\/501100003130","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp;amp; Gyne"],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The primary objective was to perform a systematic review of predictive factors for obstetric anal sphincter injury (OASI) occurrence at first vaginal delivery, with the diagnosis made by ultrasound (US\u2010OASI). The secondary objective was to report on incidence rates of sonographic anal sphincter (AS) trauma, including trauma that was not clinically reported at childbirth, among the studies providing data for our primary objective.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted a systematic search of MEDLINE, EMBASE, Web of Science, CINAHL, The Cochrane Library and\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/ClinicalTrials.gov\">ClinicalTrials.gov<\/jats:ext-link>\n                      databases. Both observational cohort studies and interventional trials were eligible for inclusion. Study eligibility was assessed independently by two authors. Random\u2010effects meta\u2010analyses were performed to pool effect estimates from studies reporting on similar predictive factors. Summary odds ratio (OR) or mean difference (MD) is reported with 95%\u2009CI. Heterogeneity was assessed using the\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      statistic. Methodological quality was assessed using the Quality in Prognosis Studies tool.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 2805 records were screened and 21 met the inclusion criteria (16 prospective cohort studies, three retrospective cohort studies and two interventional non\u2010randomized trials). Increasing gestational age at delivery (MD, 0.34 (95%\u2009CI, 0.04\u20130.64) weeks), shorter antepartum perineal body length (MD, \u22120.60 (95%\u2009CI, \u22121.09 to \u22120.11) cm), labor augmentation (OR, 1.81 (95%\u2009CI, 1.21\u20132.71)), instrumental delivery (OR, 2.13 (95%\u2009CI, 1.13\u20134.01)), in particular forceps extraction (OR, 3.56 (95%\u2009CI, 1.31\u20139.67)), shoulder dystocia (OR, 12.07 (95%\u2009CI, 1.06\u2013137.60)), episiotomy use (OR, 1.85 (95%\u2009CI, 1.11\u20133.06)) and shorter episiotomy length (MD, \u22120.40 (95%\u2009CI, \u22120.75 to \u22120.05) cm) were associated with US\u2010OASI. When pooling incidence rates, 26% (95%\u2009CI, 20\u201332%) of women who had a first vaginal delivery had US\u2010OASI (20 studies;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200988%). In studies reporting on both clinical and US\u2010OASI rates, 20% (95%\u2009CI, 14\u201328%) of women had AS trauma on ultrasound that was not reported clinically at childbirth (16 studies;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200990%). No differences were found in maternal age, body mass index, weight, subpubic arch angle, induction of labor, epidural analgesia, episiotomy angle, duration of first\/second\/active\u2010second stages of labor, vacuum extraction, neonatal birth weight or head circumference between cases with and those without US\u2010OASI. Antenatal perineal massage and use of an intrapartum pelvic floor muscle dilator did not affect the odds of US\u2010OASI. Most (81%) studies were judged to be at high risk of bias in at least one domain and only four (19%) studies had an overall low risk of bias.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Given the ultrasound evidence of structural damage to the AS in 26% of women following a first vaginal delivery, clinicians should have a low threshold of suspicion for the condition. This systematic review identified several predictive factors for this. \u00a9 2023 International Society of Ultrasound in Obstetrics and Gynecology.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/uog.26292","type":"journal-article","created":{"date-parts":[[2023,6,17]],"date-time":"2023-06-17T12:44:01Z","timestamp":1687005841000},"page":"486-496","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":35,"title":["Predictive factors for obstetric anal sphincter injury in primiparous women: systematic review and meta\u2010analysis"],"prefix":"10.1002","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0892-1931","authenticated-orcid":false,"given":"B.","family":"Packet","sequence":"first","affiliation":[{"name":"Department of Development and Regeneration, Unit of Woman and Child Catholic University of Leuven (KU Leuven)  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.\u2010S.","family":"Page","sequence":"additional","affiliation":[{"name":"Department of Development and Regeneration, Unit of Urogenital, Abdominal and Plastic Surgery Catholic University of Leuven (KU Leuven)  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Cattani","sequence":"additional","affiliation":[{"name":"Department of Development and Regeneration, Unit of Urogenital, Abdominal and Plastic Surgery Catholic University of Leuven (KU Leuven)  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Bosteels","sequence":"additional","affiliation":[{"name":"Department of Development and Regeneration, Unit of Urogenital, Abdominal and Plastic Surgery Catholic University of Leuven (KU Leuven)  Leuven Belgium"},{"name":"Department of Obstetrics and Gynaecology Imelda Hospital  Bonheiden Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4920-945X","authenticated-orcid":false,"given":"J.","family":"Deprest","sequence":"additional","affiliation":[{"name":"Department of Development and Regeneration, Unit of Urogenital, Abdominal and Plastic Surgery Catholic University of Leuven (KU Leuven)  Leuven Belgium"},{"name":"Research Department of Maternal\u2013Fetal Medicine, Institute for Women's Health University College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Richter","sequence":"additional","affiliation":[{"name":"Department of Development and Regeneration, Unit of Woman and Child Catholic University of Leuven (KU Leuven)  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,10,3]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000002841"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-022-05397-x"},{"key":"e_1_2_8_4_1","unstructured":"Royal College of Obstetricians and Gynaecologists.The management of third\u2010 and fourth\u2010degree perineal tears. 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