{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T04:01:08Z","timestamp":1791259268186,"version":"4.1.0"},"reference-count":17,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T00:00:00Z","timestamp":1776211200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T00:00:00Z","timestamp":1776211200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Development and validation of two prediction models for obstetric anal sphincter injury (OASI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Population\u2010based cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Nationwide (the Netherlands).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Population<\/jats:title>\n                    <jats:p>Data from the Netherlands Perinatal Registry, describing nulliparous women who delivered a singleton live born infant in cephalic presentation at term from 2016 to 2020, with spontaneous (SVD) or operative vaginal delivery (OVD).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Based on literature and clinical expertise, a set of potential predictors was defined and derived from the national perinatal registry. A predictive model was constructed, and accessible nomograms provided. Internal and temporal external validation was performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcome Measures<\/jats:title>\n                    <jats:p>OASI rate.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The risk of OASI in 171\u2009046 women with SVD was 4.1%. After logistic regression with step\u2010wise backward selection using Akaike Information Criterion (AIC), ten predictors were retained. These were: mediolateral episiotomy (MLE), expected fetal birth weight, duration of the 2nd stage, occipitoposterior presentation, induction of labour, epidural analgesia, Asian ethnicity, maternal age, gestational age and fetal sex. The final model had a moderate discriminative ability (AUC 0.67, 95% CI 0.67\u20130.68) and excellent calibration (Brier score 0.039). The average risk of OASI in 37\u2009547 women with OVD was 3.5%. Seven predictors were retained in the model: MLE, expected fetal birth weight, duration 2nd stage of labour, occipitoposterior fetal presentation, epidural analgesia, Asian ethnicity and gestational age. The final model had moderate discrimination (AUC 0.68, 95% CI 0.67\u20130.70) and excellent calibration (Brier score 0.032).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A prediction model for OASI was developed and validated for both nulliparous women with spontaneous vaginal delivery and with operative vaginal delivery. These models can form a basis to identify women with a high risk of OASI.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1471-0528.70245","type":"journal-article","created":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T05:20:47Z","timestamp":1776316847000},"page":"1893-1904","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Prediction of Obstetric Anal Sphincter Injury in Nulliparous Women: Model Development and Temporal Validation"],"prefix":"10.1111","volume":"133","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0915-989X","authenticated-orcid":false,"given":"Jeroen","family":"van Bavel","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynaecology Amphia Hospital  Breda the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3447-8286","authenticated-orcid":false,"given":"Anita C. J.","family":"Ravelli","sequence":"additional","affiliation":[{"name":"Department of Medical Informatics, Amsterdam UMC Location University of Amsterdam  Amsterdam the Netherlands"},{"name":"Research Institute, Amsterdam Public Health  Amsterdam the Netherlands"},{"name":"Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ameen","family":"Abu\u2010Hanna","sequence":"additional","affiliation":[{"name":"Department of Medical Informatics, Amsterdam UMC Location University of Amsterdam  Amsterdam the Netherlands"},{"name":"Research Institute, Amsterdam Public Health  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan\u2010Paul W. R.","family":"Roovers","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8337-550X","authenticated-orcid":false,"given":"Ben W.","family":"Mol","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Monash University  Clayton Victoria Australia"},{"name":"Aberdeen Centre for Women's Health Research, School of Medicine University of Aberdeen  Aberdeen UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5028-8055","authenticated-orcid":false,"given":"Jan Willem","family":"de Leeuw","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Ikazia Hospital  Rotterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,15]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2007.01502.x"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2022.11.1312"},{"issue":"119","key":"e_1_2_14_4_1","first-page":"111","article-title":"Implementatation of a Perineal Support Programme for Reduction of the Incidence of Obstetrical Anal Sphincter Injuries and the Effect of Non\u2010Compliance","volume":"230","author":"De Meutter L.","year":"2018","journal-title":"European Journal of Obstetrics & Gynecology and Reproductive Biology"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-022-05145-1"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj-2023-079014"},{"key":"e_1_2_14_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.18334"},{"key":"e_1_2_14_8_1","volume-title":"The Management of Third and Fourth Degree Perineal Tears. 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