{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T20:34:43Z","timestamp":1773347683575,"version":"3.50.1"},"reference-count":28,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2024,11,11]],"date-time":"2024-11-11T00:00:00Z","timestamp":1731283200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To assess the association between the decrease in the use of episiotomy and the incidence of obstetric anal sphincter injuries (OASIS) over a 10\u2010year period and understand their reasons by interviewing obstetricians and midwives.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Mixed\u2010methods study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>A tertiary university public maternity hospital, Paris, France.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>All patients who delivered vaginally between January 2012 and December 2021 in the maternity hospital and 20 interviews with obstetrician\u2010gynaecologists and midwives.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Quantitative data analysis using a multivariate logistic regression model, stratifying on the mode of delivery. Semi\u2010structured interview with 20 obstetricians and midwives, with an interview guide.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcome Measures<\/jats:title><jats:p>Obstetric anal sphincter injuries.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The quantitative study of 37\u2009942 women (16.1% of whom had an episiotomy and 1.4% OASIS) shows that, the incidence of episiotomy decreased from 25% to 7.6% over this 10\u2010year period. Allow on the known risk factors for OASIS, we demonstrate that its incidence rose (adjusted odds ratio 1.35, 95% confidence interval 1.09\u20131.67) for the years in which the episiotomy incidence fell below 10% for the overall population. The interviews showed professionals' apparent awareness that the decreased incidence in episiotomy (achieved by changes in departmental policy, redefining its benefit\/risk balance and acquiring new skills to manage the expulsion phase) could lead to an increased incidence of OASIS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Decreasing the episiotomy incidence appears to be associated with a rising incidence of OASIS. The optimal incidence of episiotomy remains controversial in the literature and among professionals.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.17999","type":"journal-article","created":{"date-parts":[[2024,11,12]],"date-time":"2024-11-12T04:35:16Z","timestamp":1731386116000},"page":"454-463","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Evolution of Episiotomy Incidence and Obstetric Anal Sphincter Injury Over 10\u2009Years: A Mixed\u2010Methods Study"],"prefix":"10.1111","volume":"132","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8182-7266","authenticated-orcid":false,"given":"Julie","family":"Cormier","sequence":"first","affiliation":[{"name":"Port\u2010Royal Maternity AP\u2010HP, H\u00f4pital Cochin, FHU PREMA  Paris France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lola","family":"Mirouse","sequence":"additional","affiliation":[{"name":"Centre for the Study of Social 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