{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T02:44:56Z","timestamp":1785293096826,"version":"3.55.0"},"reference-count":11,"publisher":"Georg Thieme Verlag KG","issue":"01","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:p>\n            Objective\u2003This study aimed to evaluate the rate and impact of episiotomy on maternal and newborn outcomes before and after restricted use of episiotomy.<\/jats:p><jats:p>\n            Study Design\u2003This population-based observational study used an obstetric database of all deliveries since 1990 that has been maintained with quality checks. Inclusion criteria were vaginal deliveries at \u226537 weeks. Exclusion criteria included fetal malformations, multifetal gestations, or fetal deaths known on arrival to Labor and Delivery. The primary outcomes of interest were episiotomy, perineal lacerations, and newborn outcomes. To evaluate the impact of restrictive episiotomy, data from 1990 to 1997 (35% overall episiotomy rate) were compared with data from 2010 to 2017 (2.5% overall episiotomy rate). Univariable analysis of maternal and infant outcomes were performed comparing the two-time epochs with the Pearson's Chi-squared test.<\/jats:p><jats:p>\n            Results\u2003Overall, 268,415 women met inclusion criteria and 49,089 (18.2%) had an episiotomy. The rate of episiotomy decreased from 37% of deliveries in 1990 to 2% in 2017. A total of 82,082 deliveries occurred in the 1990 to 1997 epoch and 57,183 in 2010 to 2017. Indicated use of episiotomy was associated with a significant decrease in third and fourth degree lacerations. Immediate newborn condition (5-minute Apgar's score \u22643 and umbilical artery pH &lt;7.1) and neonatal outcomes (intraventricular hemorrhage [IVH] grade 3\/4, positive culture sepsis, neonatal seizures, and neonatal demise) were not significantly different.<\/jats:p><jats:p>\n            Conclusion\u2003Selective, indicated use of episiotomy compared with routine was associated with lower rates of third\/fourth-degree lacerations with no change in neonatal outcomes. The common obstetric practice of routinely performing episiotomy, presumably to prevent perineal trauma, proved untrue when analyzed over almost three decades.<\/jats:p><jats:p>\n            Key Points\n          <\/jats:p>","DOI":"10.1055\/s-0041-1739410","type":"journal-article","created":{"date-parts":[[2021,12,2]],"date-time":"2021-12-02T23:59:31Z","timestamp":1638489571000},"page":"039-043","source":"Crossref","is-referenced-by-count":5,"title":["Episiotomy: Evolution of a Common Obstetric Practice at a Public Hospital"],"prefix":"10.1055","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4350-0585","authenticated-orcid":false,"given":"Shena J.","family":"Dillon","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David B.","family":"Nelson","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine Y.","family":"Spong","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donald D.","family":"McIntire","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth J.","family":"Leveno","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2021,12,2]]},"reference":[{"key":"ref1","volume-title":"Obstetrics: A Text-book for the Use of Students and Practitioners","author":"J W Williams","year":"1903"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1016\/S0002-9378(20)90067-4","article-title":"The prophylactic forceps operation","volume":"1","author":"J B DeLee","year":"1920","journal-title":"Am J Obstet Gynecol"},{"key":"ref3","volume-title":"Williams Obstetrics","author":"J W Williams","year":"1966","edition":"13th ed."},{"issue":"02","key":"ref4","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1016\/j.ajog.2015.05.016","article-title":"New directions in understanding how the pelvic floor prepares for and recovers from vaginal delivery","volume":"213","author":"I Nygaard","year":"2015","journal-title":"Am J Obstet Gynecol"},{"issue":"17","key":"ref5","doi-asserted-by":"crossref","first-page":"2141","DOI":"10.1001\/jama.293.17.2141","article-title":"Outcomes of routine episiotomy: a systematic review","volume":"293","author":"K Hartmann","year":"2005","journal-title":"JAMA"},{"issue":"02","key":"ref6","first-page":"CD000081","article-title":"Selective versus routine use of episiotomy for vaginal birth","volume":"2","author":"H Jiang","year":"2017","journal-title":"Cochrane Database Syst Rev"},{"issue":"01","key":"ref7","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1111\/jmwh.12283","article-title":"Obstetric anal sphincter injury and anal incontinence following vaginal birth: a systematic review and meta-analysis","volume":"60","author":"A LaCross","year":"2015","journal-title":"J Midwifery Womens Health"},{"issue":"03","key":"ref8","doi-asserted-by":"crossref","first-page":"578","DOI":"10.1097\/AOG.0b013e318195e257","article-title":"Decreased preterm births in an inner-city public hospital","volume":"113","author":"K J Leveno","year":"2009","journal-title":"Obstet Gynecol"},{"issue":"01","key":"ref9","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1097\/AOG.0000000000001523","article-title":"Practice bulletin no. 165: prevention and management of obstetric lacerations at vaginal delivery","volume":"128","author":"American College of Obstetricians and Gynecologists' Committee on Practice Bulletins\u2014Obstetrics","year":"2016","journal-title":"Obstet Gynecol"},{"issue":"156","key":"ref10","first-page":"1","article-title":"National Hospital Discharge Survey: 2001 annual summary with detailed diagnosis and procedure data","author":"L J Kozak","year":"2004","journal-title":"Vital Health Stat 13"},{"key":"ref11","volume-title":"Listening to mothers: report of the first national U.S. survey of women's childbearing experiences","author":"E D Declercq"}],"container-title":["American Journal of Perinatology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0041-1739410.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,5]],"date-time":"2024-11-05T10:40:15Z","timestamp":1730803215000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0041-1739410"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12,2]]},"references-count":11,"journal-issue":{"issue":"01","published-online":{"date-parts":[[2024,1,4]]},"published-print":{"date-parts":[[2024,1]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0041-1739410","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0735-1631","1098-8785"],"issn-type":[{"value":"0735-1631","type":"print"},{"value":"1098-8785","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12,2]]}}}