{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T18:34:19Z","timestamp":1789238059829,"version":"build-2803163510"},"reference-count":50,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2020,2,17]],"date-time":"2020-02-17T00:00:00Z","timestamp":1581897600000},"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":["Aust NZ J Obst Gynaeco"],"published-print":{"date-parts":[[2020,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Third\u2010 and fourth\u2010degree tears are associated with significant pain, discomfort and impact on quality of life and intimate relationships. Australian women experience comparatively higher rates of third\u2010 and fourth\u2010degree tears relative to countries of similar economic development.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>We aimed to conduct a comprehensive review of the literature, published over the past five years, to identify the best ways to prevent and manage third\u2010 and fourth\u2010degree perineal tears in Australian maternity centres.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>We searched the literature using the Cochrane Database of Systematic Reviews, EMBASE, MEDLINE, Maternity and Infant Care Database and Google Scholar for articles published since 2013 using key search terms. A review of reviews was undertaken given the extensive amount of literature on this topic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twenty\u2010six systematic reviews were identified. The most common risk factors reported in the literature for third\u2010 and fourth\u2010degree tears included primiparity, mother\u2019s ethnicity, large for gestational age infants and certain interventions used in labour and birth, such as instrumental deliveries. Preventive practices with varying degrees of effectiveness and often dependant on parity included: antenatal perineal massage, different maternal birthing positions, water births, warm compresses, protection of the perineum and episiotomy for instrumental births.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Third\u2010 and fourth\u2010degree perineal tears are associated with immediate and long\u2010term implications for women and health systems. Evidence\u2010based approaches can reduce the number of women who sustain a severe perineal tear and alleviate the associated disease burden for those who do.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ajo.13127","type":"journal-article","created":{"date-parts":[[2020,2,17]],"date-time":"2020-02-17T05:06:20Z","timestamp":1581915980000},"page":"175-182","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":44,"title":["Third\u2010 and fourth\u2010degree tears: A review of the current evidence for prevention and management"],"prefix":"10.1111","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9229-789X","authenticated-orcid":false,"given":"Alyce N.","family":"Wilson","sequence":"first","affiliation":[{"name":"Maternal and Child Health Program Burnet Institute Melbourne Victoria Australia"},{"name":"Melbourne School of Population and Global Health Faculty of Medicine, Dentistry and Health Sciences The University of Melbourne Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline S.E.","family":"Homer","sequence":"additional","affiliation":[{"name":"Maternal and Child Health Program Burnet Institute Melbourne Victoria Australia"},{"name":"Melbourne School of Population and Global Health Faculty of Medicine, Dentistry and Health Sciences The University of Melbourne Melbourne Victoria Australia"},{"name":"Faculty of Health University of Technology Sydney Sydney New South Wales Australia"},{"name":"School of Public Health and Preventive Medicine Monash University Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,2,17]]},"reference":[{"key":"e_1_2_8_2_1","unstructured":"Australian Commission of Quality and Safety in Health Care (ACQSHC).Second Australian Atlas of Healthcare Variation.Sydney:Australian Commission of Quality and Safety in Health Care (ACQSHC) 2017."},{"key":"e_1_2_8_3_1","volume-title":"Obstetric Trauma. 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