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Participants were categorized into two groups based on their episiotomy status. The primary outcome was the occurrence of OASIS, namely third- and fourth-degree perineal lacerations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The study included 1164 (58.3%) women who underwent episiotomy and 831 (41.7%) who did not. Women in the episiotomy group were significantly younger (27.79\u2009\u00b1\u20094.31 vs. 28.47\u2009\u00b1\u20094.51\u00a0years, p\u2009&lt;\u20090.001), had a higher prevalence of hypertensive disorders (7.7% vs. 5.2%, p\u2009=\u20090.029), experienced a slightly longer second stage of labor (3.62\u2009\u00b1\u20090.4 vs. 3.53\u2009\u00b1\u20090.4\u00a0h, p\u2009&lt;\u20090.001), and delivered newborns with higher birthweight (3366\u2009\u00b1\u2009390 vs. 3284\u2009\u00b1\u2009376\u00a0g, p\u2009&lt;\u20090.001). The OASIS rates were comparable between the groups (1.9% vs. 2.2%, p\u2009=\u20090.82), consistent across all subtypes and in a subanalysis of women with a second stage of\u2009\u2265\u20094\u00a0h (2.9% vs. 2.5%, p\u2009=\u20090.59). In adjusted multivariable analysis, episiotomy was not associated with OASIS (adjusted OR 0.95, 95% CI 0.48\u20131.84).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In nulliparous women with spontaneous vaginal delivery and a prolonged second stage (\u2265\u20093\u00a0h), episiotomy was not associated with a reduced risk of OASIS, even when the second stage exceeded 4\u00a0h. Our findings support existing guidelines that advocate against routine episiotomy in this population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00404-026-08451-x","type":"journal-article","created":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T17:12:33Z","timestamp":1777482753000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Episiotomy and the risk of obstetric anal sphincter injury in nulliparous women with a prolonged second stage"],"prefix":"10.1007","volume":"313","author":[{"given":"Gal","family":"Bachar","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shahar","family":"Rosenthal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nira","family":"Gridish","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naphtali","family":"Justman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nizar","family":"Khatib","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ido","family":"Solt","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yaniv","family":"Zipori","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,4,29]]},"reference":[{"key":"8451_CR1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2014.01.026","author":"AB Caughey","year":"2014","unstructured":"Caughey AB, Cahill AG, Guise JM et al (2014) Safe prevention of the primary cesarean delivery. 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