{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T22:28:27Z","timestamp":1793053707578,"version":"4.5.0"},"reference-count":27,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T00:00:00Z","timestamp":1767744000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T00:00:00Z","timestamp":1767744000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100004375","name":"Tel Aviv University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100004375","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Arch Gynecol Obstet"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>We aimed to evaluate the association between maternal age and the incidence of perineal injury including obstetric anal sphincter injuries (OASI) in nulliparous women.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study design<\/jats:title>\n                    <jats:p>A retrospective cohort population-based study was conducted at a tertiary university-affiliated center from January 2011 to December 2020. This study included all nulliparous women with singleton pregnancies at term (37\u201341\u00a0weeks of gestation) in vertex and occiput anterior presentation who received epidural analgesia during labor. Exclusion criteria included stillbirth, chronic and obstetric maternal conditions (hypertension, diabetes mellitus, etc.), and deliveries complicated by instrumental vaginal delivery and episiotomy were excluded. The primary outcome was the incidence of perineal injury, defined as any spontaneous perineal tear, and\/or OASI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      During the study period, a total of 39,596 nulliparouss women delivered vaginally at our center. Of them 3410 (8.61%) met the inclusion criteria, with 843 (24.7%) in the 20\u201325 age group and 2567 (75.3%) in the 30\u201335 age group. Significant differences were observed between the two age groups in terms of ethnicity, maternal weight before pregnancy and at delivery, gestational glucose challenge test results, gestational age at delivery, duration of the second stage of labor, and birth weight. The incidences of perineal injury and OASI were significantly higher in the 20\u201325 age group compared to the 30\u201335 age group (perineal injuries: 58% vs. 53.2%;\n                      <jats:italic>p<\/jats:italic>\n                      value: 0.015; OASI: 0.9% vs 0.4%,\n                      <jats:italic>p<\/jats:italic>\n                      value: 0.04). In the multivariable logistic regression analysis assessing the association between maternal age and perineal injury, the overall odds ratio for perineal injury in relation to the younger age category was calculated as 1.22 (CI 1.03\u20131.44;\n                      <jats:italic>p<\/jats:italic>\n                      value: 0.023), indicating a higher risk of perineal injury in the 20\u201325 age group compared to the 30\u201335 age group.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study suggests that younger maternal age is independently associated with an increased risk of perineal injury and OASI among nulliparous women.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00404-025-08286-y","type":"journal-article","created":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T16:45:43Z","timestamp":1767804343000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Impact of maternal age on the risk of perineal injury and obstetric anal sphincter injury in nulliparous women"],"prefix":"10.1007","volume":"313","author":[{"given":"Emmanuel","family":"Attali","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Gabbai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronen","family":"Gold","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asnat","family":"Groutz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yariv","family":"Yogev","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoav","family":"Baruch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,1,7]]},"reference":[{"key":"8286_CR1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2393-13-59","author":"LA Smith","year":"2013","unstructured":"Smith LA, Price N, Simonite V, Burns EE (2013) Incidence of and risk factors for perineal trauma: a prospective observational study. BMC Pregnancy Childbirth. https:\/\/doi.org\/10.1186\/1471-2393-13-59","journal-title":"BMC Pregnancy Childbirth"},{"key":"8286_CR2","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1046\/J.0001-6349.2001.10182.X","volume":"81","author":"E Samuelsson","year":"2002","unstructured":"Samuelsson E, Ladfors L, Lindblom BG, Hagberg H (2002) A prospective observational study on tears during vaginal delivery: occurrences and risk factors. Acta Obstet Gynecol Scand 81:44\u201349. https:\/\/doi.org\/10.1046\/J.0001-6349.2001.10182.X","journal-title":"Acta Obstet Gynecol Scand"},{"key":"8286_CR3","doi-asserted-by":"publisher","first-page":"290","DOI":"10.1097\/AOG.0000000000002444","volume":"131","author":"O Ramm","year":"2018","unstructured":"Ramm O, Woo VG, Hung YY, Chen HC, Ritterman Weintraub ML (2018) Risk factors for the development of obstetric anal sphincter injuries in modern obstetric practice. Obstet Gynecol 131:290\u2013296. https:\/\/doi.org\/10.1097\/AOG.0000000000002444","journal-title":"Obstet Gynecol"},{"key":"8286_CR4","doi-asserted-by":"publisher","first-page":"59.e1","DOI":"10.1016\/J.AJOG.2013.08.043","volume":"210","author":"H Jang\u00f6","year":"2014","unstructured":"Jang\u00f6 H, Langhoff-Roos J, Rosth\u00f8j S, Sakse A (2014) Modifiable risk factors of obstetric anal sphincter injury in primiparous women: a population-based cohort study. Am J Obstet Gynecol 210:59.e1-59.e6. https:\/\/doi.org\/10.1016\/J.AJOG.2013.08.043","journal-title":"Am J Obstet Gynecol"},{"key":"8286_CR5","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1007\/S00192-015-2768-8","volume":"27","author":"FEM Mulder","year":"2016","unstructured":"Mulder FEM, Rengerink KO, van der Post JAM, Hakvoort RA, Roovers JPWR (2016) Delivery-related risk factors for covert postpartum urinary retention after vaginal delivery. Int Urogynecol J 27:55\u201360. https:\/\/doi.org\/10.1007\/S00192-015-2768-8","journal-title":"Int Urogynecol J"},{"key":"8286_CR6","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1111\/J.1523-536X.2008.00222.X","volume":"35","author":"I R\u00e5destad","year":"2008","unstructured":"R\u00e5destad I, Olsson A, Nissen E, Rubertsson C (2008) Tears in the vagina, perineum, sphincter ani, and rectum and first sexual intercourse after childbirth: a nationwide follow-up. Birth 35:98\u2013106. https:\/\/doi.org\/10.1111\/J.1523-536X.2008.00222.X","journal-title":"Birth"},{"key":"8286_CR7","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1016\/J.AJOG.2005.06.086","volume":"194","author":"G Tegerstedt","year":"2006","unstructured":"Tegerstedt G, Miedel A, M\u00e6hle-Schmidt M, Nyr\u00e9n O, Hammarstr\u00f6m M (2006) Obstetric risk factors for symptomatic prolapse: a population-based approach. Am J Obstet Gynecol 194:75\u201381. https:\/\/doi.org\/10.1016\/J.AJOG.2005.06.086","journal-title":"Am J Obstet Gynecol"},{"key":"8286_CR8","doi-asserted-by":"publisher","first-page":"425.e1","DOI":"10.1016\/J.AJOG.2012.06.055","volume":"207","author":"EC Evers","year":"2012","unstructured":"Evers EC, Blomquist JL, McDermott KC, Handa VL (2012) Obstetrical anal sphincter laceration and anal incontinence 5\u201310 years after childbirth. Am J Obstet Gynecol 207:425.e1-425.e6. https:\/\/doi.org\/10.1016\/J.AJOG.2012.06.055","journal-title":"Am J Obstet Gynecol"},{"key":"8286_CR9","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD006672.PUB3","author":"V Aasheim","year":"2017","unstructured":"Aasheim V, Nilsen ABV, Reinar LM, Lukasse M (2017) Perineal techniques during the second stage of labour for reducing perineal trauma. Cochrane Database Syst Rev. https:\/\/doi.org\/10.1002\/14651858.CD006672.PUB3","journal-title":"Cochrane Database Syst Rev"},{"key":"8286_CR10","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1016\/J.EJOGRB.2016.10.013","volume":"207","author":"NS Lund","year":"2016","unstructured":"Lund NS, Persson LKG, Jang\u00f6 H, Gommesen D, Westergaard HB (2016) Episiotomy in vacuum-assisted delivery affects the risk of obstetric anal sphincter injury: a systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 207:193\u2013199. https:\/\/doi.org\/10.1016\/J.EJOGRB.2016.10.013","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"8286_CR11","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1016\/J.EJOGRB.2010.03.002","volume":"150","author":"V Revicky","year":"2010","unstructured":"Revicky V, Nirmal D, Mukhopadhyay S, Morris EP, Nieto JJ (2010) Could a mediolateral episiotomy prevent obstetric anal sphincter injury? Eur J Obstet Gynecol Reprod Biol 150:142\u2013146. https:\/\/doi.org\/10.1016\/J.EJOGRB.2010.03.002","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"8286_CR12","doi-asserted-by":"publisher","first-page":"104","DOI":"10.1111\/J.1471-0528.2007.01554.X","volume":"115","author":"JW De Leeuw","year":"2008","unstructured":"De Leeuw JW, De Wit C, Kuijken JPJA, Bruinse HW (2008) Mediolateral episiotomy reduces the risk for anal sphincter injury during operative vaginal delivery. BJOG 115:104\u2013108. https:\/\/doi.org\/10.1111\/J.1471-0528.2007.01554.X","journal-title":"BJOG"},{"key":"8286_CR13","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD000081.PUB3","author":"H Jiang","year":"2017","unstructured":"Jiang H, Qian X, Carroli G, Garner P (2017) Selective versus routine use of episiotomy for vaginal birth. Cochrane Database Syst Rev. https:\/\/doi.org\/10.1002\/14651858.CD000081.PUB3","journal-title":"Cochrane Database Syst Rev"},{"key":"8286_CR14","doi-asserted-by":"publisher","DOI":"10.1186\/S12884-020-03447-0","author":"MH Jansson","year":"2020","unstructured":"Jansson MH, Franz\u00e9n K, Hiyoshi A, Tegerstedt G, Dahlgren H, Nilsson K (2020) Risk factors for perineal and vaginal tears in primiparous women\u2014the prospective POPRACT-cohort study. BMC Pregnancy Childbirth. https:\/\/doi.org\/10.1186\/S12884-020-03447-0","journal-title":"BMC Pregnancy Childbirth"},{"key":"8286_CR15","doi-asserted-by":"publisher","first-page":"1097","DOI":"10.1111\/1471-0528.14269","volume":"124","author":"KE Fitzpatrick","year":"2017","unstructured":"Fitzpatrick KE, Tuffnell D, Kurinczuk JJ, Knight M (2017) Pregnancy at very advanced maternal age: a UK population-based cohort study. BJOG 124:1097\u20131106. https:\/\/doi.org\/10.1111\/1471-0528.14269","journal-title":"BJOG"},{"key":"8286_CR16","doi-asserted-by":"publisher","first-page":"558.e1","DOI":"10.1016\/j.ajog.2010.07.039","volume":"203","author":"Y Yogev","year":"2010","unstructured":"Yogev Y, Melamed N, Bardin R, Tenenbaum-Gavish K, Ben-Shitrit G, Ben-Haroush A (2010) Pregnancy outcome at extremely advanced maternal age. Am J Obstet Gynecol 203:558.e1-558.e7. https:\/\/doi.org\/10.1016\/j.ajog.2010.07.039","journal-title":"Am J Obstet Gynecol"},{"key":"8286_CR17","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpobgyn.2020.06.006","author":"E Attali","year":"2020","unstructured":"Attali E, Yogev Y (2020) The impact of advanced maternal age on pregnancy outcome. Best Pract Res Clin Obstet Gynaecol. https:\/\/doi.org\/10.1016\/j.bpobgyn.2020.06.006","journal-title":"Best Pract Res Clin Obstet Gynaecol"},{"key":"8286_CR18","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1097\/AOG.0000000000001523","volume":"128","author":"Practice Bulletin No","year":"2016","unstructured":"Practice Bulletin No (2016) 165: prevention and management of obstetric lacerations at vaginal delivery. Obstet Gynecol 128:e1-15. https:\/\/doi.org\/10.1097\/AOG.0000000000001523","journal-title":"Obstet Gynecol"},{"key":"8286_CR19","doi-asserted-by":"publisher","first-page":"461","DOI":"10.1080\/14767058.2016.1174999","volume":"30","author":"AC Gimovsky","year":"2017","unstructured":"Gimovsky AC, Guarente J, Berghella V (2017) Prolonged second stage in nulliparous with epidurals: a systematic review. J Matern Fetal Neonatal Med 30:461\u2013465. https:\/\/doi.org\/10.1080\/14767058.2016.1174999","journal-title":"J Matern Fetal Neonatal Med"},{"key":"8286_CR20","doi-asserted-by":"publisher","DOI":"10.1111\/birt.12267","author":"M Edqvist","year":"2017","unstructured":"Edqvist M, Hildingsson I, Mollberg M, Lundgren I, Lindgren H (2017) Midwives\u2019 management during the second stage of labor in relation to second-degree tears\u2014an experimental study. Birth. https:\/\/doi.org\/10.1111\/birt.12267","journal-title":"Birth"},{"issue":"23","key":"8286_CR21","doi-asserted-by":"publisher","DOI":"10.3390\/jcm11236990","volume":"11","author":"Y Baruch","year":"2022","unstructured":"Baruch Y, Gold R, Eisenberg H, Amir H, Yogev Y, Groutz A (2022) Substantial obstetric anal sphincter injury during vacuum assisted delivery: an obstetrical issue or device related? J Clin Med 11(23):6990. https:\/\/doi.org\/10.3390\/jcm11236990","journal-title":"J Clin Med"},{"key":"8286_CR22","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-012-1893-x","author":"MM Corton","year":"2013","unstructured":"Corton MM, McIntire DD, Twickler DM, Atnip S, Schaffer JI, Leveno KJ (2013) Endoanal ultrasound for detection of sphincter defects following childbirth. Int Urogynecol J Pelvic Floor Dysfunct. https:\/\/doi.org\/10.1007\/s00192-012-1893-x","journal-title":"Int Urogynecol J Pelvic Floor Dysfunct"},{"issue":"15","key":"8286_CR23","doi-asserted-by":"publisher","first-page":"1554","DOI":"10.3109\/14767058.2013.794212","volume":"26","author":"A Aviram","year":"2013","unstructured":"Aviram A, Raban O, Melamed N, Hadar E, Wiznitzer A, Yogev Y (2013) The association between young maternal age and pregnancy outcome. J Matern Fetal Neonatal Med 26(15):1554\u20131558. https:\/\/doi.org\/10.3109\/14767058.2013.794212","journal-title":"J Matern Fetal Neonatal Med"},{"issue":"6","key":"8286_CR24","doi-asserted-by":"publisher","first-page":"1369","DOI":"10.1007\/s00404-012-2460-x","volume":"286","author":"N Steiner","year":"2012","unstructured":"Steiner N, Weintraub AY, Wiznitzer A, Sergienko R, Sheiner E (2012) Episiotomy: the final cut? Arch Gynecol Obstet 286(6):1369\u20131373. https:\/\/doi.org\/10.1007\/s00404-012-2460-x","journal-title":"Arch Gynecol Obstet"},{"key":"8286_CR25","doi-asserted-by":"publisher","DOI":"10.1097\/SPV.0000000000000777","author":"VG Woo","year":"2020","unstructured":"Woo VG, Hung YY, Ritterman-Weintraub ML, Painter CE, Ramm O (2020) A clinical risk model to predict obstetric anal sphincter injuries in laboring patients. Female Pelvic Med Reconstr Surg. https:\/\/doi.org\/10.1097\/SPV.0000000000000777","journal-title":"Female Pelvic Med Reconstr Surg"},{"key":"8286_CR26","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-021-04752-8","author":"HH Chill","year":"2021","unstructured":"Chill HH, Guedalia J, Lipschuetz M, Shimonovitz T, Unger R, Shveiky D et al (2021) Prediction model for obstetric anal sphincter injury using machine learning. Int Urogynecol J. https:\/\/doi.org\/10.1007\/s00192-021-04752-8","journal-title":"Int Urogynecol J"},{"key":"8286_CR27","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2022.06.021","author":"NA Okeahialam","year":"2024","unstructured":"Okeahialam NA, Sultan AH, Thakar R (2024) The prevention of perineal trauma during vaginal birth. Am J Obstet Gynecol. https:\/\/doi.org\/10.1016\/j.ajog.2022.06.021","journal-title":"Am J Obstet Gynecol"}],"container-title":["Archives of Gynecology and Obstetrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00404-025-08286-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00404-025-08286-y","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00404-025-08286-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T16:45:48Z","timestamp":1767804348000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00404-025-08286-y"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,7]]},"references-count":27,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["8286"],"URL":"https:\/\/doi.org\/10.1007\/s00404-025-08286-y","relation":{},"ISSN":["1432-0711"],"issn-type":[{"value":"1432-0711","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,7]]},"assertion":[{"value":"20 October 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 November 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 January 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"The trial was conducted in accordance with the Declaration of Helsinki (2000) for human studies (IRB number TLV-0284-08).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics"}}],"article-number":"19"}}