{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T12:39:06Z","timestamp":1787315946679,"version":"build-2736575974"},"reference-count":24,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T00:00:00Z","timestamp":1776297600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T00:00:00Z","timestamp":1776297600000},"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":["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>Vacuum\u2010assisted delivery is a major risk factor for obstetric anal sphincter injury (OASI), yet agreement is lacking on whether mediolateral episiotomy mitigates risk. The objective of this study was to evaluate whether episiotomy during vacuum\u2010assisted delivery in nulliparous women affects the risk of OASI and to identify subgroups who may benefit from it.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Material and Methods<\/jats:title>\n                    <jats:p>A retrospective cohort study including all nulliparous singleton pregnancies delivered by vacuum\u2010assisted delivery at a tertiary center (January\u20092011\u2013December\u20092022). Twin deliveries and multiparous women were excluded. Mediolateral episiotomy was performed according to the physician's preference and clinical judgment.<\/jats:p>\n                    <jats:p>The primary outcome was the risk of OASI. The diagnosis of OASI was based on a clinical assessment immediately after delivery. Multivariable logistic regression was used to assess the association between mediolateral episiotomy and OASI while adjusting for potential confounders: maternal age, prepregnancy BMI, gestational age, prolonged second stage, occiput posterior, and epidural analgesia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 7951 vacuum\u2010assisted deliveries, 7201 (90.6%) had an episiotomy and 750 (9.4%) did not. The groups were similar, though episiotomy cases more often had a prolonged second stage (32.0% vs 25.9%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001), occiput posterior (12.7% vs 9.6%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.03), and birthweight \u22653500\u2009g (25.4% vs 21.7%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.03). OASI occurred twice as often without episiotomy (2.8% vs 1.4%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.01). After adjustment, episiotomy remained (adjusted odds ratio 0.42, 95% CI 0.25\u20130.70). The number needed to treat (NNT) with episiotomy to prevent one OASI was 64 overall, and was lower in the presence of intrapartum risk factors: 16 with prolonged second stage, 33 with occiput posterior, and 27 when birthweight exceeded 3500\u2009g. Postpartum hemorrhage requiring transfusion occurred more frequently with episiotomy (3.9% vs 1.5%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001), corresponding to a number needed to harm (NNH) of 43. Neonatal outcomes did not differ significantly.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In nulliparous women, mediolateral episiotomy during vacuum\u2010assisted delivery was associated with a 50% reduction in OASI. The preventive effect of mediolateral episiotomy was greater when multiple intrapartum risk factors were present.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/aogs.70208","type":"journal-article","created":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T10:41:28Z","timestamp":1776336088000},"page":"1287-1294","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Episiotomy is associated with a reduced risk of obstetric anal sphincter injury in nulliparous vacuum\u2010assisted deliveries, particularly in high\u2010risk cases"],"prefix":"10.1111","volume":"105","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2631-9461","authenticated-orcid":false,"given":"Matan","family":"Anteby","sequence":"first","affiliation":[{"name":"Gray Faculty of Medical &amp; Health Sciences, Tel Aviv Sourasky Medical Center Lis Hospital for Women's Health, Tel Aviv University  Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tally","family":"Pinchas\u2010Cohen","sequence":"additional","affiliation":[{"name":"Gray Faculty of Medical &amp; Health Sciences, Tel Aviv Sourasky Medical Center Lis Hospital for Women's Health, Tel Aviv University  Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-4502-6736","authenticated-orcid":false,"given":"Anat","family":"Lavie","sequence":"additional","affiliation":[{"name":"Gray Faculty of Medical &amp; Health Sciences, Tel Aviv Sourasky Medical Center Lis Hospital for Women's Health, Tel Aviv University  Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharon","family":"Maslovitz","sequence":"additional","affiliation":[{"name":"Gray Faculty of Medical &amp; Health Sciences, Tel Aviv Sourasky Medical Center Lis Hospital for Women's Health, Tel Aviv University  Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6104-5216","authenticated-orcid":false,"given":"Ronen","family":"Gold","sequence":"additional","affiliation":[{"name":"Gray Faculty of Medical &amp; Health Sciences, Tel Aviv Sourasky Medical Center Lis Hospital for Women's Health, Tel Aviv University  Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2980-5112","authenticated-orcid":false,"given":"Asnat","family":"Groutz","sequence":"additional","affiliation":[{"name":"Gray Faculty of Medical &amp; Health Sciences, Tel Aviv Sourasky Medical Center Lis Hospital for Women's Health, Tel Aviv University  Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yariv","family":"Yogev","sequence":"additional","affiliation":[{"name":"Gray Faculty of Medical &amp; Health Sciences, Tel Aviv Sourasky Medical Center Lis Hospital for Women's Health, Tel Aviv University  Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoav","family":"Baruch","sequence":"additional","affiliation":[{"name":"Gray Faculty of Medical &amp; Health Sciences, Tel Aviv Sourasky Medical Center Lis Hospital for Women's Health, Tel Aviv University  Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,16]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2017.11.569"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2022.11.1312"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2025.06.014"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijgo.15698"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.16663"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm11236990"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2007.01554.x"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2008.01960.x"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj-2023-079014"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-022-05145-1"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2016.10.013"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2025.01.029"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-025-07184-0"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00404-020-05809-7"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.16092"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000003764"},{"key":"e_1_2_13_18_1","volume-title":"WHO labour care guide: user's manual","author":"World Health Organization","year":"2020"},{"key":"e_1_2_13_19_1","volume-title":"The management of third\u2010 and fourth\u2010degree perineal tears. 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