{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T22:11:34Z","timestamp":1772057494098,"version":"3.50.1"},"reference-count":24,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2018,11,16]],"date-time":"2018-11-16T00:00:00Z","timestamp":1542326400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100004103","name":"Landsp\u00edtali H\u00e1sk\u00f3lasj\u00fakrah\u00fas","doi-asserted-by":"publisher","award":["04052011\/Tilv.16"],"award-info":[{"award-number":["04052011\/Tilv.16"]}],"id":[{"id":"10.13039\/501100004103","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Birth"],"published-print":{"date-parts":[[2019,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Obstetric anal sphincter injuries lead frequently to short\u2010 and long\u2010term consequences for the mother, including perineal pain, genital prolapse, and sexual problems. The aim of the study was to evaluate whether the implementation of an intervention program in the second stage of labor involving altered perineal support techniques reduced severe perineal trauma.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>All women reaching the second stage of labor and giving birth vaginally to singleton babies at Landsp\u00edtali University Hospital (comprising 76% of births in Iceland in 2013) were enrolled in a cohort study. Data were recorded retrospectively for 2008\u20102010 and prospectively in 2012\u20102014, for a total of 16 336 births. During 2011, an intervention program was implemented, involving all midwives and obstetricians working in the labor wards. Two professionals assessed and agreed on classification of every perineal tear.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The prevalence of obstetric anal sphincter injuries decreased from 5.9% to 3.7% after the implementation (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001). Third\u2010degree tears decreased by 40%, and fourth\u2010degree tears decreased by 56% (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001). The prevalence of first\u2010degree tears increased from 25.8% to 33.1%, whereas second\u2010degree tears decreased from 44.7% to 36.6% between the before and after study periods. Severe perineal trauma was linked to birthweight, and this did not change despite the new intervention.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Active intervention to reduce perineal trauma was associated with an overall significant decrease in obstetric anal sphincter injuries. Good perineal visualization, manual perineal support, and controlled delivery of the fetal head were essential components for reducing perineal trauma.<\/jats:p><\/jats:sec>","DOI":"10.1111\/birt.12409","type":"journal-article","created":{"date-parts":[[2018,11,16]],"date-time":"2018-11-16T13:20:10Z","timestamp":1542374410000},"page":"371-378","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Effects of an intervention program for reducing severe perineal trauma during the second stage of labor"],"prefix":"10.1111","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1855-4717","authenticated-orcid":false,"given":"Edda","family":"Sveinsdottir","sequence":"first","affiliation":[{"name":"Midwifery Division, Faculty of Nursing University of Iceland Reykjavik Iceland"},{"name":"Department of Obstetrics and Gynecology, Women\u2019s Clinic Landsp\u00edtali University Hospital Reykjavik Iceland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6094-8755","authenticated-orcid":false,"given":"Helga","family":"Gottfredsdottir","sequence":"additional","affiliation":[{"name":"Midwifery Division, Faculty of Nursing University of Iceland Reykjavik Iceland"},{"name":"Department of Obstetrics and Gynecology, Women\u2019s Clinic Landsp\u00edtali University Hospital Reykjavik Iceland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7136-6283","authenticated-orcid":false,"given":"Anna S.","family":"Vernhardsdottir","sequence":"additional","affiliation":[{"name":"Midwifery Division, Faculty of Nursing University of Iceland Reykjavik Iceland"},{"name":"Department of Obstetrics and Gynecology, Women\u2019s Clinic Landsp\u00edtali University Hospital Reykjavik Iceland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gudny B.","family":"Tryggvadottir","sequence":"additional","affiliation":[{"name":"Department of Social Sciences University of Iceland Reykjavik Iceland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5419-0909","authenticated-orcid":false,"given":"Reynir T.","family":"Geirsson","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Women\u2019s Clinic Landsp\u00edtali University Hospital Reykjavik Iceland"},{"name":"Faculty of Medicine University of Iceland Reykjavik Iceland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,11,16]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e3181eda77a"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1034\/j.1600-0412.1998.771005.x"},{"key":"e_1_2_6_4_1","first-page":"29","volume-title":"The Management of Third and Fourth Degree Perineal Tears","author":"Fernando RJ","year":"2007"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2009.04.033"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2393-13-59"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-016-3176-4"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.13431"},{"key":"e_1_2_6_9_1","first-page":"CD006672","article-title":"Perineal techniques during the second stage of labour for reducing perineal trauma","volume":"6","author":"Aasheim V","year":"2017","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.wombi.2018.04.015"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.12274"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/jan.12005"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1067\/mob.2001.113855"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2012.03293.x"},{"issue":"21","key":"e_1_2_6_15_1","first-page":"3461","article-title":"Do we know enough? A quality assessment of the Finnish intervention to prevent obstetric anal sphincter injuries","volume":"29","author":"Skriver\u2010M\u00f8ller AC","year":"2016","journal-title":"J Matern Fetal Neonatal Med"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2018.02.010"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.13108"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajo.12286"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.12896"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-016-3015-7"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.13103"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2015-008346"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1197\/jamia.M1749"},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2012-001649"},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.13472"}],"container-title":["Birth"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fbirt.12409","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/birt.12409","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/birt.12409","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/birt.12409","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,10]],"date-time":"2023-09-10T18:46:21Z","timestamp":1694371581000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/birt.12409"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,11,16]]},"references-count":24,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2019,6]]}},"alternative-id":["10.1111\/birt.12409"],"URL":"https:\/\/doi.org\/10.1111\/birt.12409","archive":["Portico"],"relation":{},"ISSN":["0730-7659","1523-536X"],"issn-type":[{"value":"0730-7659","type":"print"},{"value":"1523-536X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,11,16]]},"assertion":[{"value":"2018-05-29","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-10-20","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-11-16","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}