{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T07:20:40Z","timestamp":1790148040365,"version":"4.0.1"},"reference-count":26,"publisher":"Georg Thieme Verlag KG","issue":"09","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2022,7]]},"abstract":"<jats:p>\n            Objective\u2003This study aimed to assess whether a prolonged second stage of labor is an independent predictor of obstetric anal sphincter injury (OASI) in a contemporary cohort of nulliparous and term parturients, and to evaluate whether predelivery factors can accurately predict OASI.<\/jats:p><jats:p>\n            Study Design\u2003This was a nested case-control study within a cohort of consecutive nulliparous term parturients with a singleton gestation who underwent a vaginal delivery at a single institution between January 2014 and January 2015. Cases were defined as women with a third- or fourth-degree laceration at the time of delivery, and controls were women without a third- or fourth-degree laceration. A prolonged second stage was defined as a second stage of \u22653\u2009hours. Univariable and multivariable regression analyses were performed to examine the relationship between prolonged second stage of labor and third- or fourth-degree lacerations. Receiver operator curves were developed to assess the predictive capacity of predelivery information for third- and fourth-degree lacerations.<\/jats:p><jats:p>\n            Results\u2003Of 1,197 births, 63 women had third- or fourth-degree lacerations (5.3%). With each additional hour of the second stage, the rate of OASI increased, with 2.9% of women with a second stage of &lt;1 hour with OASI, 3.5% between 1 and 2\u2009hours, 5.7% between 2 and 3\u2009hours, 7.8% between 3 and 4\u2009hours, 16.1% between 4 and 5\u2009hours, and 28.6% among women with a second stage length &gt;5\u2009hours (p\u2009&lt;\u20090.001). In multivariable regression analysis, operative vaginal delivery (adjusted odds ratio [aOR]\u2009=\u20095.92, 95% confidence interval [CI]: 3.17\u201311.07) and a prolonged second stage (aOR\u2009=\u20091.92, 95% CI: 1.06\u20133.51) were independent predictors of third- and fourth-degree lacerations. A predictive model was developed from these results (area under the curve [AUC]\u2009=\u20090.75, 95% CI: 0.68\u20130.81).<\/jats:p><jats:p>\n            Conclusion\u2003Prolonged second stage of labor is a predictor of OASI, after adjustment for operative vaginal delivery. A model using predelivery risk factors has a reasonable prediction of OASI.<\/jats:p><jats:p>\n            Key Points\n          <\/jats:p>","DOI":"10.1055\/s-0040-1718878","type":"journal-article","created":{"date-parts":[[2020,10,20]],"date-time":"2020-10-20T23:05:52Z","timestamp":1603235152000},"page":"0937-0943","source":"Crossref","is-referenced-by-count":12,"title":["Prolonged Second Stage of Labor and Anal Sphincter Injury in a Contemporary Cohort of Term Nulliparas"],"prefix":"10.1055","volume":"39","author":[{"given":"Mariam","family":"Naqvi","sequence":"additional","affiliation":[{"name":"Division of Maternal Fetal Medicine Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, California"},{"name":"Division of Maternal Fetal Medicine Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1917-2278","authenticated-orcid":false,"given":"Elana F.","family":"Jaffe","sequence":"additional","affiliation":[{"name":"Department of Maternal, Child, and Family Health, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina"},{"name":"Department of Social Medicine, Center for Bioethics, University of North Carolina, Chapel Hill, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilona T.","family":"Goldfarb","sequence":"additional","affiliation":[{"name":"Division of Maternal Fetal Medicine Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allison S.","family":"Bryant","sequence":"additional","affiliation":[{"name":"Division of Maternal Fetal Medicine Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Blair J.","family":"Wylie","sequence":"additional","affiliation":[{"name":"Division of Maternal Fetal Medicine Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts"},{"name":"Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anjali J.","family":"Kaimal","sequence":"additional","affiliation":[{"name":"Division of Maternal Fetal Medicine Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2020,10,20]]},"reference":[{"issue":"13","key":"ref1","doi-asserted-by":"crossref","first-page":"1695","DOI":"10.1111\/1471-0528.12886","article-title":"Impact of third- and fourth-degree perineal tears at first birth on subsequent pregnancy outcomes: a cohort study","volume":"121","author":"L C Edozien","year":"2014","journal-title":"BJOG"},{"issue":"04","key":"ref2","doi-asserted-by":"crossref","first-page":"357.e1","DOI":"10.1016\/j.ajog.2009.08.003","article-title":"Second-stage labor duration in nulliparous women: relationship to maternal and perinatal outcomes","volume":"201","author":"D J Rouse","year":"2009","journal-title":"Am J Obstet Gynecol"},{"issue":"04","key":"ref3","doi-asserted-by":"crossref","first-page":"347.e1","DOI":"10.1016\/j.ajog.2010.11.019","article-title":"Third- and fourth-degree perineal tears: prevalence and risk factors in the third 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