{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,21]],"date-time":"2025-08-21T17:39:35Z","timestamp":1755797975247,"version":"3.40.5"},"reference-count":28,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2019,7,23]],"date-time":"2019-07-23T00:00:00Z","timestamp":1563840000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","award":["PI16\/01387"],"award-info":[{"award-number":["PI16\/01387"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2019,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Forceps use is the main risk factor for levator ani muscle (<jats:styled-content style=\"fixed-case\">LAM<\/jats:styled-content>) injuries. We believe that the disengagement of the forceps branches before delivery of the fetal head could influence <jats:styled-content style=\"fixed-case\">LAM<\/jats:styled-content> injuries, so we aimed to determine the influence of the disengagement of the forceps on the occurrence of <jats:styled-content style=\"fixed-case\">LAM<\/jats:styled-content> avulsion during forceps delivery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and methods<\/jats:title><jats:p>A prospective, observational, multicenter study was conducted with 261 women who underwent forceps delivery. The women were classified according to whether the branches of the forceps had been disengaged before delivery of the fetal head. <jats:styled-content style=\"fixed-case\">LAM<\/jats:styled-content> avulsion was defined using a multislice mode (3 central slices).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In all, 255 women completed the study (160 without disengagement and 95 with disengagement). <jats:styled-content style=\"fixed-case\">LAM<\/jats:styled-content> avulsions were observed in 37.9% of women in the group with disengagement and in 41.9% of women in the group without disengagement. The crude <jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> (without disengagement vs with disengagement) for avulsion was 0.90 (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.49\u20101.67, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.757) and an adjusted <jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> of 0.82 (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.40\u20101.69, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.603).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>We did not observe a statistically significant reduction in the LAM avulsion rate with disengagement of the forceps branches before delivery of the fetal head.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.13682","type":"journal-article","created":{"date-parts":[[2019,6,27]],"date-time":"2019-06-27T09:00:34Z","timestamp":1561626034000},"page":"1413-1419","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Influence of the disengagement of the forceps on levator ani muscle injuries in instrumental delivery: A multicenter study"],"prefix":"10.1111","volume":"98","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9571-3219","authenticated-orcid":false,"given":"Jos\u00e9 Antonio","family":"Sainz","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Valme University Hospital Seville Spain"},{"name":"Department of Obstetrics and Gynecology University of Seville Seville Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alicia","family":"Mart\u00edn\u2010Mart\u00ednez","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Complejo Asistencial Universitario de Gran Canarias Gran Canarias Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4528-2473","authenticated-orcid":false,"given":"Enrique","family":"Gonz\u00e1lez\u2010Diaz","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Complejo Asistencial Universitario de Leon (CAULE) Leon Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Camino","family":"Fern\u00e1ndez\u2010Fern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Complejo Asistencial Universitario de Leon (CAULE) Leon Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ismael","family":"Ortega","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Complejo Asistencial Universitario de Gran Canarias Gran Canarias Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Margarita","family":"Medina","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Complejo Asistencial Universitario de Gran Canarias Gran Canarias Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alfonso","family":"Fern\u00e1ndez\u2010Corona","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Complejo Asistencial Universitario de Leon (CAULE) Leon Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana","family":"Fern\u00e1ndez\u2010Palac\u00edn","sequence":"additional","affiliation":[{"name":"Biostatistics Unit Department of Preventive Medicine and Public Health University of Seville Seville Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3079-5583","authenticated-orcid":false,"given":"Jos\u00e9 Antonio","family":"Garc\u00eda\u2010Mejido","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Valme University Hospital Seville Spain"},{"name":"Department of Obstetrics and Gynecology University of Seville Seville Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,7,23]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.jp.7211735"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000001142"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e31828b72cb"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2010.02704.x"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.10132"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000000825"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.12592"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.11080"},{"key":"e_1_2_8_10_1","unstructured":"WegnerEK BemsteinIM.Operative vaginal delivery. 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