{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T16:07:53Z","timestamp":1791562073045,"version":"4.3.4"},"reference-count":31,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2025,8,20]],"date-time":"2025-08-20T00:00:00Z","timestamp":1755648000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,8,20]],"date-time":"2025-08-20T00:00:00Z","timestamp":1755648000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","award":["NIHR202869"],"award-info":[{"award-number":["NIHR202869"]}],"id":[{"id":"10.13039\/501100000272","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":[[2026,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Although childbirth\u2010related perineal trauma affects the majority of women after vaginal birth, very few healthcare resources are allocated to reducing morbidity from perineal trauma. Wound complications are frequent after perineal trauma has been sustained; however, we know little about which factors are predictive of developing a wound issue. To target possible interventions effectively, it is crucial that those at higher risk are identified. Here, we perform a systematic review and meta\u2010analysis of prognostic factors for sustaining wound complications after childbirth\u2010related perineal trauma.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Material and Methods<\/jats:title>\n                    <jats:p>Medline, Embase, Web of Science, and CINAHL were searched from inception to December 2024 using relevant search terms. There were no restrictions on language or year of publication. Observational studies that investigated two or more potential prognostic factors for wound complications after childbirth related\u2010perineal trauma, where adjusted risks were calculated, were eligible for inclusion. We included all types of tears, sustained through spontaneous or assisted vaginal birth. Meta\u2010analysis was performed where five or more studies investigated a particular prognostic factor for perineal wound complications. Odds ratios (ORs) were pooled using a random effects model. The review was prospectively registered in PROSPERO (CRD42023458738).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Fifteen studies were eligible for inclusion, involving 71409 women. Studies included were published between 2006 and 2024 across six different countries. Assisted vaginal birth (10 studies, 65\u2009375 women: OR 2.77, 95% confidence interval [CI] 1.89\u20134.06) was a significant risk factor for wound complication. Raised body mass index (six studies, 64\u2009770 women: OR 1.33, 95% CI 0.56\u20133.18) was not a significant risk factor. Prolonged second stage of labor, smoking, and episiotomy were each investigated in three primary studies; therefore, data was insufficient for meta\u2010analysis; however, individual studies indicated that there might be an association with perineal wound complication.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Assisted vaginal birth is a significant risk factor for perineal wound complication after childbirth\u2010related perineal trauma. Overall, there are limited studies investigating prognostic factors for perineal wound complication after childbirth related\u2010perineal trauma. Whilst we highlight potential prognostic factors, we recommend that a robust, well\u2010powered primary research study with clearly defined wound complication outcomes and prognostic factors is needed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/aogs.70041","type":"journal-article","created":{"date-parts":[[2025,8,21]],"date-time":"2025-08-21T04:54:51Z","timestamp":1755752091000},"page":"1247-1264","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Prognostic factors for wound complications after childbirth\u2010related perineal trauma: A systematic review and meta\u2010analysis"],"prefix":"10.1111","volume":"105","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0983-7590","authenticated-orcid":false,"given":"Rebecca","family":"Man","sequence":"first","affiliation":[{"name":"Department of Applied Health Sciences, School of Health Sciences, College of Medicine and Health University of Birmingham  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanvi","family":"Bhatia","sequence":"additional","affiliation":[{"name":"Warwick Hospital South Warwickshire University NHS Foundation Trust  Warwick UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice","family":"Sitch","sequence":"additional","affiliation":[{"name":"Department of Applied Health Sciences, School of Health Sciences, College of Medicine and Health University of Birmingham  Birmingham UK"},{"name":"National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1247-429X","authenticated-orcid":false,"given":"R. Katie","family":"Morris","sequence":"additional","affiliation":[{"name":"Department of Applied Health Sciences, School of Health Sciences, College of Medicine and Health University of Birmingham  Birmingham UK"},{"name":"Birmingham Women's Hospital Birmingham Women's and Children's NHS Foundation Trust  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9817-4313","authenticated-orcid":false,"given":"V. Hodgetts","family":"Morton","sequence":"additional","affiliation":[{"name":"Department of Applied Health Sciences, School of Health Sciences, College of Medicine and Health University of Birmingham  Birmingham UK"},{"name":"Birmingham Women's Hospital Birmingham Women's and Children's NHS Foundation Trust  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the CHAPTER group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,8,20]]},"reference":[{"key":"e_1_2_13_2_1","unstructured":"Listen to Mums: ending the postcode lottery on perinatal care. A report by the all\u2010party parliamentary group on birth trauma. Accessed May 12 2025.https:\/\/www.theo\u2010clarke.org.uk\/birth\u2010trauma\u2010report"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2393-13-59"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.midw.2020.102748"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/acps.13595"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-021-91799-8"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.12845"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2019.05.038"},{"key":"e_1_2_13_9_1","unstructured":"RCOG.The Management of Third and Fourth Degree Tears. Green top guideline No 29. Accessed May 12 2025.https:\/\/www.rcog.org.uk\/media\/5jeb5hzu\/gtg\u201029.pdf"},{"key":"e_1_2_13_10_1","unstructured":"The Chapter Study\u2014Childbirth Acquired Perineal Trauma Study. Accessed May 12 2025.https:\/\/www.birmingham.ac.uk\/research\/applied\u2010health\/research\/chapter\u2010study"},{"key":"e_1_2_13_11_1","unstructured":"PROSPERO. A series of systematic reviews exploring childbirth related perineal trauma. Accessed May 12 2025.https:\/\/www.crd.york.ac.uk\/PROSPERO\/view\/CRD42023458738"},{"key":"e_1_2_13_12_1","unstructured":"Preferred reporting items for systematic reviews and meta\u2010analyses (PRISMA). Accessed May 12 2025.https:\/\/www.prisma\u2010statement.org\/prisma\u20102020\u2010checklist"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-158-4-201302190-00009"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.k4597"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2015-010247"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.1080\/01443615.2022.2033961"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00404-019-05165-1"},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/SPV.0000000000000274"},{"key":"e_1_2_13_19_1","first-page":"QC08","article-title":"Risk factors for peripartum wound dehiscence","volume":"12","author":"Kingsbury B","year":"2018","journal-title":"Clin Diagn Res"},{"key":"e_1_2_13_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000000833"},{"key":"e_1_2_13_21_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm12083036"},{"key":"e_1_2_13_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2012.12.025"},{"key":"e_1_2_13_23_1","first-page":"145","article-title":"The incidence and associated factors of perineal wound infection following vaginal delivery in Charoenkrung Pracharak hospital, Bangkok, Thailand","volume":"31","author":"Thongtip N","year":"2023","journal-title":"Thai J Obstet Gynaecol"},{"key":"e_1_2_13_24_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41372-018-0252-2"},{"key":"e_1_2_13_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2006.06.085"},{"issue":"20","key":"e_1_2_13_26_1","first-page":"8857","article-title":"Risk factors and preventive measures for postoperative infection in episiotomy of puerperal","volume":"28","author":"Zhang H","year":"2017","journal-title":"Biomed Res"},{"key":"e_1_2_13_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajogmf.2023.100883"},{"key":"e_1_2_13_28_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-024-06691-w"},{"key":"e_1_2_13_29_1","doi-asserted-by":"publisher","DOI":"10.1097\/SPV.0000000000001642"},{"key":"e_1_2_13_30_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijgo.14530"},{"key":"e_1_2_13_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(19)30773-1"},{"key":"e_1_2_13_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2022.08.037"}],"container-title":["Acta Obstetricia et Gynecologica Scandinavica"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/aogs.70041","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/aogs.70041","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/aogs.70041","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T21:01:25Z","timestamp":1783458085000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1111\/aogs.70041"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,20]]},"references-count":31,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1111\/aogs.70041"],"URL":"https:\/\/doi.org\/10.1111\/aogs.70041","archive":["Portico"],"relation":{},"ISSN":["0001-6349","1600-0412"],"issn-type":[{"value":"0001-6349","type":"print"},{"value":"1600-0412","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,20]]},"assertion":[{"value":"2025-05-13","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-06","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-20","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}