{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T01:15:39Z","timestamp":1789780539729,"version":"4.0.1"},"reference-count":24,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2013,3,6]],"date-time":"2013-03-06T00:00:00Z","timestamp":1362528000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2013,7]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To explore: (1) the antenatal and postnatal morbidity experienced by women in relation to operative vaginal delivery (<jats:styled-content style=\"fixed-case\">OVD<\/jats:styled-content>); and (2) the impact of restrictive versus routine use of episiotomy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Longitudinal prospective cohort study embedded within a two\u2010centre randomised controlled trial (<jats:styled-content style=\"fixed-case\">RCT<\/jats:styled-content>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Two <jats:styled-content style=\"fixed-case\">UK<\/jats:styled-content> tertiary\u2010level maternity units.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>Antenatally recruited participants of an <jats:styled-content style=\"fixed-case\">RCT<\/jats:styled-content> of restrictive versus routine use of episiotomy at <jats:styled-content style=\"fixed-case\">OVD<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A self\u2010completing questionnaire was administered antenatally, before hospital discharge, at 6\u00a0weeks and at 1\u00a0year postpartum.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Urinary and anal incontinence, dyspareunia, perineal pain and psychological morbidity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Longitudinal data have revealed that morbidities historically associated with <jats:styled-content style=\"fixed-case\">OVD<\/jats:styled-content> were often as prevalent, if not more prevalent, in the third trimester of pregnancy than postpartum. Restrictive episiotomy use was associated with: a higher incidence of perineal pain in the immediate postpartum period (98.9% restrictive versus 87.8% routine, <jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content>\u00a01.10, 95%\u00a0<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\u00a01.01\u20131.21); greater psychological morbidity in the immediate postpartum period (mean scores on the <jats:styled-content style=\"fixed-case\">E<\/jats:styled-content>dinburgh <jats:styled-content style=\"fixed-case\">P<\/jats:styled-content>ostnatal <jats:styled-content style=\"fixed-case\">D<\/jats:styled-content>epression <jats:styled-content style=\"fixed-case\">S<\/jats:styled-content>cale, <jats:styled-content style=\"fixed-case\">E<\/jats:styled-content>dinburgh <jats:styled-content style=\"fixed-case\">P<\/jats:styled-content>ostnatal <jats:styled-content style=\"fixed-case\">D<\/jats:styled-content>epression <jats:styled-content style=\"fixed-case\">S<\/jats:styled-content>core (<jats:styled-content style=\"fixed-case\">EPDS<\/jats:styled-content>) 6.7 restrictive versus 5.1 routine; <jats:italic>P\u00a0<\/jats:italic>=\u00a00.01 ); and more stress urinary incontinence at 6\u00a0weeks postpartum (42.2% restrictive versus 27.2% routine, <jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content>\u00a01.55, 95%\u00a0<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\u00a01.00\u20132.40); however, this had resolved by 1\u00a0year. No other differences were found between the groups at 6\u00a0weeks and 1\u00a0year postpartum.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Morbidities previously attributed to <jats:styled-content style=\"fixed-case\">OVD<\/jats:styled-content> may in fact be present antenatally, to a greater or similar degree. A restrictive approach to the use of episiotomy at <jats:styled-content style=\"fixed-case\">OVD<\/jats:styled-content> may increase rates of urinary morbidity, in particular stress incontinence and perineal pain, in the immediate postpartum period.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.12184","type":"journal-article","created":{"date-parts":[[2013,3,6]],"date-time":"2013-03-06T14:31:48Z","timestamp":1362580308000},"page":"1020-1027","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":61,"title":["Morbidity experienced by women before and after operative vaginal delivery: prospective cohort study nested within a two\u2010centre randomised controlled trial of restrictive versus routine use of episiotomy"],"prefix":"10.1111","volume":"120","author":[{"given":"M","family":"Macleod","sequence":"first","affiliation":[{"name":"Division of Clinical &amp; Population Sciences &amp; Education University of Dundee Ninewells Hospital &amp; Medical School Dundee UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K","family":"Goyder","sequence":"additional","affiliation":[{"name":"St Michael's Hospital Bristol UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L","family":"Howarth","sequence":"additional","affiliation":[{"name":"St Michael's Hospital Bristol UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R","family":"Bahl","sequence":"additional","affiliation":[{"name":"St Michael's Hospital Bristol UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B","family":"Strachan","sequence":"additional","affiliation":[{"name":"St Michael's Hospital Bristol UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"DJ","family":"Murphy","sequence":"additional","affiliation":[{"name":"Academic Department of Obstetrics &amp; Gynaecology Trinity College University of Dublin and Coombe Women &amp; Infants University Hospital Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2013,3,6]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2004.01.013"},{"key":"e_1_2_6_3_1","first-page":"326","article-title":"Anal incontinence after childbirth","volume":"166","author":"Eason E","year":"2002","journal-title":"CMAJ"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1067\/mob.2001.113855"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2004.02.064"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD000081.pub2"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2007.03.004"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9378(99)70104-3"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2008.01960.x"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2003.12.027"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02050307"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/0304-3959(75)90044-5"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.150.6.782"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1542-2011.1974.tb00384.x"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2008.02107.x"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.295.6601.749"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2005.00840.x"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2011.02928.x"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0029-7844(99)00364-6"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.289.6445.587"},{"key":"e_1_2_6_21_1","article-title":"Does episiotomy prevent perineal trauma and pelvic floor relaxation?","author":"Klein M","year":"1992","journal-title":"Online J Curr Clin Trials"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2007.01540.x"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(05)80085-6"},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2004.10.601"},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2008.01961.x"}],"container-title":["BJOG: An International Journal of Obstetrics &amp; 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