{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T02:57:20Z","timestamp":1792292240313,"version":"4.4.0"},"reference-count":46,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2014,1,9]],"date-time":"2014-01-09T00:00:00Z","timestamp":1389225600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2015,9,1]],"date-time":"2015-09-01T00:00:00Z","timestamp":1441065600000},"content-version":"tdm","delay-in-days":600,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["ijgo.org","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Intl J Gynecology &amp; Obste"],"published-print":{"date-parts":[[2014,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Severe perineal lacerations represent a significant complication of normal labor with a strong impact on quality of life.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To identify factors that lead to the occurrence of severe perineal lacerations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Search strategy<\/jats:title><jats:p>We searched MEDLINE, Scopus, <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/ClinicalTrials.gov\">ClinicalTrials.gov<\/jats:ext-link>, the Cochrane Central Register of Controlled Trials, Google Scholar and reference lists from all included studies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Selection criteria<\/jats:title><jats:p>We included prospective and retrospective observational studies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data collection and analysis<\/jats:title><jats:p>Predetermined data were collected and analyzed with the Mantel\u2013Haenszel fixed\u2010effects model or the DerSimonian\u2013Laird random\u2010effects model.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main results<\/jats:title><jats:p>The meta\u2010analysis included 22 studies (n = 651 934). Women with severe perineal tears were more likely to have had heavier infants (mean difference 192.88 g [95% CI, 139.80\u2013245.96 g]), an episiotomy (OR 3.82 [95% CI, 1.96\u20137.42]), or an operative vaginal delivery (OR 5.10 [95% CI, 3.33\u20137.83]). Epidural anesthesia (OR 1.95 [95% CI, 1.63\u20132.32]), labor induction (OR 1.08 [95% CI, 1.02\u20131.14]), and labor augmentation (OR 1.95 [95% CI, 1.56\u20132.44]) were also more common among women with perineal lacerations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Various factors contribute to the occurrence of perineal lacerations. Future studies should consistently evaluate all examined parameters to determine their possible interrelation.<\/jats:p><\/jats:sec>","DOI":"10.1016\/j.ijgo.2013.09.034","type":"journal-article","created":{"date-parts":[[2014,1,9]],"date-time":"2014-01-09T04:32:37Z","timestamp":1389241957000},"page":"6-14","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":180,"title":["Risk factors for severe perineal lacerations during childbirth"],"prefix":"10.1002","volume":"125","author":[{"given":"Vasileios","family":"Pergialiotis","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitrios","family":"Vlachos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Athanasios","family":"Protopapas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaliopi","family":"Pappa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgios","family":"Vlachos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2014,1,9]]},"reference":[{"key":"e_1_2_7_2_2","unstructured":"Queensland Maternity and Neonatal Clinical Guidelines Program.Queensland Maternity and Neonatal Clinical Guideline: Perineal care.http:\/\/www.health.qld.gov.au\/qcg\/documents\/g_pericare.pdf Published April 2012"},{"key":"e_1_2_7_3_2","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e31820afaf2"},{"key":"e_1_2_7_4_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.gco.0000191901.69320.a0"},{"issue":"5","key":"e_1_2_7_5_2","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1097\/GCO.0b013e32834a91e8","article-title":"Overlapping compared with end\u2010to\u2010end repair of third and fourth degree obstetric anal sphincter tears","volume":"23","author":"Farrell S.A.","year":"2011","journal-title":"Curr Opin Obstet Gynecol"},{"issue":"3","key":"e_1_2_7_6_2","first-page":"272","article-title":"Third degree tears and episiotomy","volume":"22","author":"Shihadeh A.S.","year":"2001","journal-title":"Saudi Med J"},{"key":"e_1_2_7_7_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.283.15.2008"},{"key":"e_1_2_7_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.wombi.2011.08.003"},{"key":"e_1_2_7_9_2","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.060410"},{"issue":"2","key":"e_1_2_7_10_2","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1111\/j.0006-341X.2000.00455.x","article-title":"Trim and fill: A simple funnel\u2010plot\u2010based method of testing and adjusting for publication bias in meta\u2010analysis","volume":"56","author":"Duval S.","year":"2000","journal-title":"Biometrics"},{"key":"e_1_2_7_11_2","doi-asserted-by":"publisher","DOI":"10.1067\/mob.2000.105403"},{"key":"e_1_2_7_12_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.1994.tb13582.x"},{"key":"e_1_2_7_13_2","doi-asserted-by":"publisher","DOI":"10.1080\/00016340500408283"},{"issue":"8","key":"e_1_2_7_14_2","first-page":"752","article-title":"Risk factors for third\u2010degree perineal tears in vaginal delivery, with an analysis of episiotomy types","volume":"46","author":"Bodner\u2010Adler B.","year":"2001","journal-title":"J Reprod Med"},{"key":"e_1_2_7_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.midw.2006.04.004"},{"issue":"4","key":"e_1_2_7_16_2","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1016\/S0306-5456(00)00090-5","article-title":"Risk factors for third degree perineal ruptures during delivery","volume":"108","author":"de Leeuw J.W.","year":"2001","journal-title":"BJOG"},{"key":"e_1_2_7_17_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2005.00835.x"},{"key":"e_1_2_7_18_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1463-1318.2011.02620.x"},{"key":"e_1_2_7_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2010.11.019"},{"key":"e_1_2_7_20_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00404-009-1063-7"},{"key":"e_1_2_7_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2004.09.035"},{"issue":"3","key":"e_1_2_7_22_2","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1034\/j.1600-0412.2001.080003229.x","article-title":"Third and fourth degree perineal tears. Predictor factors in a referral hospital","volume":"80","author":"Jand\u00e9r C.","year":"2001","journal-title":"Acta Obstet Gynecol Scand"},{"key":"e_1_2_7_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0020-7292(00)00305-2"},{"key":"e_1_2_7_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9378(97)70506-4"},{"key":"e_1_2_7_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2006.06.078"},{"issue":"6","key":"e_1_2_7_26_2","first-page":"797","article-title":"Association between median episiotomy and severe perineal lacerations in primiparous women","volume":"156","author":"Labrecque M.","year":"1997","journal-title":"CMAJ"},{"key":"e_1_2_7_27_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2006.10.893"},{"key":"e_1_2_7_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2004.02.064"},{"key":"e_1_2_7_29_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-2002-33088"},{"key":"e_1_2_7_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9378(99)70104-3"},{"key":"e_1_2_7_31_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2000.tb11093.x"},{"key":"e_1_2_7_32_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00404-004-0610-5"},{"issue":"10","key":"e_1_2_7_33_2","doi-asserted-by":"crossref","first-page":"989","DOI":"10.1111\/j.0001-6349.2004.00647.x","article-title":"Anal incontinence after obstetric sphincter tears: incidence in a Norwegian county","volume":"83","author":"Norderval S.","year":"2004","journal-title":"Acta Obstet Gynecol Scand"},{"key":"e_1_2_7_34_2","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e3181eda77a"},{"key":"e_1_2_7_35_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2009.04.033"},{"key":"e_1_2_7_36_2","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e31816c4402"},{"key":"e_1_2_7_37_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2008.01960.x"},{"issue":"2","key":"e_1_2_7_38_2","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1111\/j.1471-0528.2007.01540.x","article-title":"Pelvic floor disorders 4 years after first delivery: a comparative study of restrictive versus systematic episiotomy","volume":"115","author":"Fritel X.","year":"2008","journal-title":"BJOG"},{"key":"e_1_2_7_39_2","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e31816de899"},{"key":"e_1_2_7_40_2","doi-asserted-by":"publisher","DOI":"10.1097\/SPV.0b013e3182a5f98e"},{"key":"e_1_2_7_41_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijgo.2009.03.013"},{"key":"e_1_2_7_42_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijgo.2009.05.025"},{"key":"e_1_2_7_43_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9378(99)70669-1"},{"key":"e_1_2_7_44_2","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0b013e31822827b8"},{"key":"e_1_2_7_45_2","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2253-6-15"},{"issue":"3","key":"e_1_2_7_46_2","first-page":"247","article-title":"Optimal dose of an anesthetic in epidural anesthesia and its effect on labor duration and administration of vacuum extractor and forceps","volume":"38","author":"Cutura N.","year":"2011","journal-title":"Clin Exp Obstet Gynecol"},{"issue":"5","key":"e_1_2_7_47_2","first-page":"1","article-title":"Epidural and spinal anesthesia use during labor: 27\u2010state reporting area, 2008","volume":"59","author":"Osterman M.J.","year":"2011","journal-title":"Natl Vital Stat Rep"}],"container-title":["International Journal of Gynecology &amp; Obstetrics"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/api.elsevier.com\/content\/article\/PII:S0020729214000022?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/api.elsevier.com\/content\/article\/PII:S0020729214000022?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1016%2Fj.ijgo.2013.09.034","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1016%2Fj.ijgo.2013.09.034","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1016\/j.ijgo.2013.09.034","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,5]],"date-time":"2023-10-05T00:24:25Z","timestamp":1696465465000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1016\/j.ijgo.2013.09.034"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,1,9]]},"references-count":46,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2014,4]]}},"alternative-id":["10.1016\/j.ijgo.2013.09.034"],"URL":"https:\/\/doi.org\/10.1016\/j.ijgo.2013.09.034","archive":["Portico"],"relation":{},"ISSN":["0020-7292","1879-3479"],"issn-type":[{"value":"0020-7292","type":"print"},{"value":"1879-3479","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,1,9]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Risk factors for severe perineal lacerations during childbirth","name":"articletitle","label":"Article Title"},{"value":"International Journal of Gynecology & Obstetrics","name":"journaltitle","label":"Journal Title"},{"value":"http:\/\/dx.doi.org\/10.1016\/j.ijgo.2013.09.034","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"Copyright \u00a9 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.","name":"copyright","label":"Copyright"}]}}