{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T11:09:13Z","timestamp":1788433753939,"version":"build-2803163510"},"reference-count":34,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2019,2,1]],"date-time":"2019-02-01T00:00:00Z","timestamp":1548979200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2019,2,1]],"date-time":"2019-02-01T00:00:00Z","timestamp":1548979200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","ejog.org","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["European Journal of Obstetrics & Gynecology and Reproductive Biology"],"published-print":{"date-parts":[[2019,2]]},"DOI":"10.1016\/j.ejogrb.2018.12.019","type":"journal-article","created":{"date-parts":[[2018,12,20]],"date-time":"2018-12-20T03:39:09Z","timestamp":1545277149000},"page":"127-133","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":14,"special_numbering":"C","title":["Which characteristics of the episiotomy and perineum are associated with a lower risk of obstetric anal sphincter injury in instrumental deliveries"],"prefix":"10.1016","volume":"233","author":[{"given":"Enrique","family":"Gonzalez-D\u00edaz","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camino","family":"Fern\u00e1ndez Fern\u00e1ndez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose Manuel","family":"Gonzalo Orden","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfonso","family":"Fern\u00e1ndez Corona","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.ejogrb.2018.12.019_bib0005","doi-asserted-by":"crossref","first-page":"1725","DOI":"10.1007\/s00192-015-2747-0","article-title":"Obstetric anal sphincter injuries: review of anatomical factors and modifiable second stage interventions","volume":"26","author":"Kapoor","year":"2015","journal-title":"Int Urogynecol J"},{"key":"10.1016\/j.ejogrb.2018.12.019_bib0010","doi-asserted-by":"crossref","first-page":"1333","DOI":"10.1002\/bjs.4369","article-title":"Meta-analysis to de- termine the incidence of obstetric anal sphincter damage","volume":"90","author":"Oberwalder","year":"2003","journal-title":"Br J Surg"},{"key":"10.1016\/j.ejogrb.2018.12.019_bib0015","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1111\/j.1471-0528.2007.01502.x","article-title":"Long term effects of anal sphincter rupture during vaginal delivery: fecal incontinence and sexual complaints","volume":"115","author":"Mous","year":"2008","journal-title":"BJOG"},{"key":"10.1016\/j.ejogrb.2018.12.019_bib0020","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1097\/01.gco.0000192983.76976.68","article-title":"Head injuries after instrumental vaginal deliveries","volume":"18","author":"Doumouchtsis","year":"2006","journal-title":"Curr Opin Obstet Gynecol"},{"key":"10.1016\/j.ejogrb.2018.12.019_bib0025","first-page":"383","article-title":"Risk factors for third degree perineal ruptures during delivery","volume":"108","author":"de Leeuw","year":"2001","journal-title":"Br J Obstet Gynaecol"},{"key":"10.1016\/j.ejogrb.2018.12.019_bib0030","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1067\/mob.2003.547","article-title":"Risk factors for perineal injury during delivery","volume":"189","author":"Christianson","year":"2003","journal-title":"Am J Obstet Gynecol"},{"key":"10.1016\/j.ejogrb.2018.12.019_bib0035","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1007\/s00192-005-1297-2","article-title":"Risk factors for obstetrical anal sphincter lacerations","volume":"16","author":"Dandolu","year":"2005","journal-title":"Int Urogynecol J Pelvic Floor Dysfunct"},{"issue":"13","key":"10.1016\/j.ejogrb.2018.12.019_bib0040","doi-asserted-by":"crossref","first-page":"1695","DOI":"10.1111\/j.1471-0528.2008.01960.x","article-title":"A randomized controlled trial of routine versus restrictive use of episiotomy at operative vaginal delivery: a multicentre pilot study","volume":"115","author":"Murphy","year":"2008","journal-title":"BJOG"},{"issue":"8","key":"10.1016\/j.ejogrb.2018.12.019_bib0045","doi-asserted-by":"crossref","first-page":"1020","DOI":"10.1111\/1471-0528.12184","article-title":"Morbidity experienced by women before and after operative vaginal delivery: prospective cohort study nested within a two-centre randomized controlled trial of restrictive versus routine use of episiotomy","volume":"120","author":"Macleod","year":"2013","journal-title":"BJOG"},{"issue":"Issue 2","key":"10.1016\/j.ejogrb.2018.12.019_bib0050","article-title":"Selective versus routine use of episiotomy for vaginal birth","author":"Jiang","year":"2017","journal-title":"Cochrane Database Syst Rev"},{"issue":"12","key":"10.1016\/j.ejogrb.2018.12.019_bib0055","doi-asserted-by":"crossref","first-page":"1365","DOI":"10.3109\/00016340903295626","article-title":"Lateral episiotomy protects primiparous but not multiparous women from obstetric anal sphincter rupture","volume":"88","author":"R\u00e4is\u00e4nen","year":"2009","journal-title":"Acta Obstet Gynecol Scand"},{"issue":"5","key":"10.1016\/j.ejogrb.2018.12.019_bib0060","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1177\/1403494811404276","article-title":"High episiotomy rate protects from obstetric anal sphincter ruptures: a birth register-study on delivery intervention policies in Finland","volume":"39","author":"R\u00e4is\u00e4nen","year":"2011","journal-title":"Scand J Public Health"},{"key":"10.1016\/j.ejogrb.2018.12.019_bib0065","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1111\/j.1471-0528.2005.00835.x","article-title":"Does the angle of episiotomy affect the incidence of anal sphincter injury?","volume":"113","author":"Eogan","year":"2006","journal-title":"BJOG"},{"issue":"5","key":"10.1016\/j.ejogrb.2018.12.019_bib0070","doi-asserted-by":"crossref","first-page":"1053","DOI":"10.1097\/AOG.0b013e31816c4402","article-title":"Decreasing the incidence of anal sphincter tears during delivery","volume":"111","author":"Laine","year":"2008","journal-title":"Obstet Gynecol"},{"issue":"4","key":"10.1016\/j.ejogrb.2018.12.019_bib0075","doi-asserted-by":"crossref","first-page":"901","DOI":"10.1097\/AOG.0b013e3181eda77a","article-title":"A multicenter interventional program to reduce the incidence of anal sphincter tears","volume":"116","author":"Hals","year":"2010","journal-title":"Obstet Gynecol"},{"issue":"3","key":"10.1016\/j.ejogrb.2018.12.019_bib0080","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1016\/j.ijgo.2010.09.015","article-title":"Evaluation of the incision angle of mediolateral episiotomy at 60 degrees","volume":"112","author":"Kalis","year":"2011","journal-title":"Int J Gynaecol Obstet"},{"key":"10.1016\/j.ejogrb.2018.12.019_bib0085","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1007\/s00192-014-2491-x","article-title":"Trigonometric characteristics of episiotomy and risks for obstetric anal sphincter injuries in operative vaginal delivery","volume":"26","author":"Gonzalez-D\u00edaz","year":"2015","journal-title":"Int Urogynecol J"},{"issue":"5 Pt 353 1","key":"10.1016\/j.ejogrb.2018.12.019_bib0090","doi-asserted-by":"crossref","first-page":"1180","DOI":"10.1016\/S0002-9378(99)70104-3","article-title":"Episiotomy, operative vaginal delivery, and significant perinatal trauma in nulliparous women","volume":"181","author":"Robinson","year":"1999","journal-title":"Am J Obstet Gynecol"},{"issue":"3","key":"10.1016\/j.ejogrb.2018.12.019_bib0095","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1016\/j.ajog.2006.06.078","article-title":"Operative vaginal delivery and midline episiotomy: a bad combination for the perineum","volume":"195","author":"Kudish","year":"2006","journal-title":"Am J Obstet Gynecol"},{"issue":"1","key":"10.1016\/j.ejogrb.2018.12.019_bib0100","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1111\/j.1471-0528.2007.01554.x","article-title":"Mediolateral episiotomy reduces the risk for anal sphincter injury during operative vaginal delivery","volume":"115","author":"de Leeuw","year":"2008","journal-title":"BJOG"},{"issue":"5","key":"10.1016\/j.ejogrb.2018.12.019_bib0105","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1016\/j.ajog.2012.02.008","article-title":"The effect of a mediolateral episiotomy during operative vaginal delivery on the risk of developing obstetrical anal sphincter injuries","volume":"206","author":"de Vogel","year":"2012","journal-title":"Am J Obstet Gynecol"},{"key":"10.1016\/j.ejogrb.2018.12.019_bib0110","doi-asserted-by":"crossref","first-page":"1370","DOI":"10.1111\/j.1471-0528.2012.03455.x","article-title":"Vacuum-assisted deliveries and the risk of obstetric anal sphincter injuries\u2014a retrospective register-based study in Finland","volume":"119","author":"R\u00e4is\u00e4nen","year":"2012","journal-title":"BJOG"},{"issue":"2","key":"10.1016\/j.ejogrb.2018.12.019_bib0115","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1016\/j.ijgo.2007.07.022","article-title":"Definitions of mediolateral episiotomy in Europe","volume":"100","author":"Kalis","year":"2008","journal-title":"Int J Gynaecol Obstet"},{"issue":"12","key":"10.1016\/j.ejogrb.2018.12.019_bib0120","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.1111\/j.1471-0528.2003.03030.x","article-title":"Differences in episiotomy technique between midwives and doctors","volume":"110","author":"Tincello","year":"2003","journal-title":"BJOG"},{"issue":"8","key":"10.1016\/j.ejogrb.2018.12.019_bib0125","doi-asserted-by":"crossref","first-page":"1156","DOI":"10.1111\/j.1471-0528.2005.00645.x","article-title":"Are mediolateral episiotomies actually medio-lateral?","volume":"112","author":"Andrews","year":"2005","journal-title":"BJOG"},{"issue":"14","key":"10.1016\/j.ejogrb.2018.12.019_bib0130","doi-asserted-by":"crossref","first-page":"2368","DOI":"10.3109\/14767058.2015.1086328","article-title":"Differences in characteristics of mediolateral episiotomy in proffesionals at the same hospital","volume":"29","author":"Gonzalez-D\u00edaz","year":"2016","journal-title":"J Matern Fetal Neonatal Med"},{"key":"10.1016\/j.ejogrb.2018.12.019_bib0135","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1111\/j.1471-0528.2012.03293.x","article-title":"Episiotomy characteristics and risks for obstetric anal sphincter injuries: a case\u2013control study","volume":"119","author":"Stedenfeldt","year":"2012","journal-title":"BJOG"},{"issue":"1","key":"10.1016\/j.ejogrb.2018.12.019_bib0140","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1016\/j.ijgo.2008.05.026","article-title":"The incision angle of mediolateral episiotomy before delivery and after repair","volume":"103","author":"Kalis","year":"2008","journal-title":"Int J Gynaecol Obstet"},{"issue":"7","key":"10.1016\/j.ejogrb.2018.12.019_bib0145","first-page":"635","article-title":"Significance of the angle of episiotomy","volume":"18","author":"Kalis","year":"2011","journal-title":"Salud i Ciencia"},{"key":"10.1016\/j.ejogrb.2018.12.019_bib0150","doi-asserted-by":"crossref","first-page":"1877","DOI":"10.1111\/jog.12432","article-title":"Comparison between two incision angles of mediolateral episiotomy in primiparous women: a randomised controlled trial","volume":"40","author":"El-Din","year":"2014","journal-title":"J Obstet Gynaecol Res"},{"issue":"March (3)","key":"10.1016\/j.ejogrb.2018.12.019_bib0155","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1007\/s00192-016-3166-6","article-title":"Behavior of perineum during delivery before fetal head expulsion","volume":"28","author":"Gonzalez-D\u00edaz","year":"2017","journal-title":"Int Urogynecol J"},{"key":"10.1016\/j.ejogrb.2018.12.019_bib0160","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/j.ijgo.2009.08.021","article-title":"A prospective multicenter audit of labor-room episiotomy and anal sphincter injury assessment in the Netherlands","volume":"108","author":"van Dillen","year":"2010","journal-title":"Int J Gynaecol Obstet"},{"key":"10.1016\/j.ejogrb.2018.12.019_bib0165","first-page":"23","article-title":"Association of spontaneous perineal stretching during delivery with perineal lacerations","volume":"50","author":"Walfisch","year":"2005","journal-title":"J Reprod Med"},{"key":"10.1016\/j.ejogrb.2018.12.019_bib0170","doi-asserted-by":"crossref","first-page":"1116","DOI":"10.3109\/14767050902994820","article-title":"Is the policy of restrictive episiotomy generalizable? A prospective observational study","volume":"22","author":"Lai","year":"2009","journal-title":"J Matern Fetal Neonatal Med"}],"container-title":["European Journal of Obstetrics & Gynecology and Reproductive Biology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0301211518311503?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0301211518311503?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2025,10,4]],"date-time":"2025-10-04T05:43:52Z","timestamp":1759556632000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0301211518311503"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,2]]},"references-count":34,"alternative-id":["S0301211518311503"],"URL":"https:\/\/doi.org\/10.1016\/j.ejogrb.2018.12.019","relation":{},"ISSN":["0301-2115"],"issn-type":[{"value":"0301-2115","type":"print"}],"subject":[],"published":{"date-parts":[[2019,2]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Which characteristics of the episiotomy and perineum are associated with a lower risk of obstetric anal sphincter injury in instrumental deliveries","name":"articletitle","label":"Article Title"},{"value":"European Journal of Obstetrics & Gynecology and Reproductive Biology","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.ejogrb.2018.12.019","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2018 Elsevier B.V. All rights reserved.","name":"copyright","label":"Copyright"}]}}