{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T07:09:48Z","timestamp":1784790588592,"version":"3.55.0"},"reference-count":21,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T00:00:00Z","timestamp":1775779200000},"content-version":"vor","delay-in-days":9,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"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":["Aust NZ J Obst Gynaeco"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Episiotomy may be performed during an instrumental vaginal birth. The evidence that the procedure is associated with less obstetric anal sphincter injuries (OASI) in this setting is scarce.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>We undertook a retrospective cohort study to ascertain whether the performance of episiotomy was associated with fewer obstetric anal sphincter injuries in patients undergoing instrumental births over a 14\u2010year period from one tertiary institution.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>Every vaginal birth at Te Toka Tumai Auckland from gestational age 36\u2009weeks was included in a retrospective cohort spanning the years 2008\u20132021. Forceps\u2010assisted and Vacuum\u2010Extraction and Sequential Instrumental births were included. Univariable analysis was performed for the forceps, Vacuum\u2010extraction and Sequential Instrumental birth strata. Multivariable analysis was performed for all births using generalized linear models including maternal, neonatal and labour characteristics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Between 2008 and 2021 there were 3714 forceps\u2010assisted births, 7793 Vacuum\u2010extraction births and 505 Sequential Instrumental births. The majority of these births were carried out with the use of a mediolateral episiotomy (89%, 66%, and 93.5% respectively) and OASI occurred in 9.5%, 5.2%, and 16.2%. Among people having an instrumental birth (all groups forceps, vacuum\u2010extraction and sequential instrumental births), mediolateral episiotomy was associated with lower relative risks of OASI after adjusting for type of instrument, parity and other clinical and demographic factors (RR 0.68 (0.58\u20130.80)).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Mediolateral episiotomy was associated with a lower relative risk of OASI in patients having operative vaginal births.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ajo.70126","type":"journal-article","created":{"date-parts":[[2026,4,11]],"date-time":"2026-04-11T04:35:33Z","timestamp":1775882133000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Episiotomy and Obstetric Anal Sphincter Injury in the Setting of Instrumental Vaginal Birth: A Retrospective Cohort Study"],"prefix":"10.1111","volume":"66","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4096-5339","authenticated-orcid":false,"given":"Meghan G.","family":"Hill","sequence":"first","affiliation":[{"name":"University of Auckland  Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aimee","family":"Humphries","sequence":"additional","affiliation":[{"name":"Te Whatu Ora | Te Toka Tumai Auckland  Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Wilson","sequence":"additional","affiliation":[{"name":"University of Auckland  Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda D.","family":"Harvey","sequence":"additional","affiliation":[{"name":"University of Auckland  Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robin","family":"Cronin","sequence":"additional","affiliation":[{"name":"University of Auckland  Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6944-381X","authenticated-orcid":false,"given":"John M. D.","family":"Thompson","sequence":"additional","affiliation":[{"name":"University of Auckland  Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lynn C.","family":"Sadler","sequence":"additional","affiliation":[{"name":"Te Whatu Ora | Te Toka Tumai Auckland  Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,10]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000003764"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.16092"},{"key":"e_1_2_8_4_1","volume-title":"Implementation Guide for Maternity Sites in the Roll\u2010Out Phase 2017\u20132018","author":"OASI Care Bundle Project Team","year":"2018"},{"key":"e_1_2_8_5_1","unstructured":"Women's Healthcare Australasia \u201cPreliminary results of WHA National Collaborative on reducing third and fourth degree perineal tears \u201d(2018) https:\/\/women.wcha.asn.au\/collaborative\/evaluation. 3."},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijgo.14385"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijgo.14101"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2008.01960.x"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2004.09.035"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.12363"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2008.02.002"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2007.01554.x"},{"issue":"8","key":"e_1_2_8_13_1","first-page":"583","article-title":"The Value of Routine Episiotomy in Forceps Deliveries","volume":"22","author":"TC S. 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