{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T22:29:50Z","timestamp":1767824990190,"version":"3.49.0"},"reference-count":20,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2012,5,28]],"date-time":"2012-05-28T00:00:00Z","timestamp":1338163200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Paediatric Perinatal Epid"],"published-print":{"date-parts":[[2012,9]]},"abstract":"<jats:sec><jats:title>Abstract<\/jats:title><\/jats:sec><jats:sec><jats:title>Background:<\/jats:title><jats:p>The incidence of third\u2010 and fourth\u2010degree perineal tears during vaginal childbirth is being increasingly used as an indicator of the safety and quality of maternity health care services. In order to make fair comparisons across hospitals it may be necessary to estimate a probability of severe perineal tears for every woman, taking into account her risk profile.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods:<\/jats:title><jats:p>Logistic regression analysis was used to estimate the probabilities of third\u2010 and fourth\u2010degree tears (<jats:italic>n<\/jats:italic>\u2003=\u20031582; 2.4%) in 65\u2003598 vaginal births in publicly funded hospitals in South Australia, 2002\u201308.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results:<\/jats:title><jats:p>Maternal age \u226525 years, primiparity, instrument assistance, Asian or African ethnicity, shoulder dystocia and increasing birthweight were all identified as factors that are associated with an increased risk of perineal tears. In parous women, episiotomy, with or without instrument assistance, was associated with more tears; but among nulliparous women, episiotomy was associated with significantly fewer tears when forceps assistance was required, and showed little or no association with tearing in vacuum\u2010assisted or unassisted (spontaneous) births.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion:<\/jats:title><jats:p>The probabilities of severe perineal tears in first\u2010time mothers giving birth to a term singleton with cephalic presentation, may range from under 1% to over 40%, according to a minimalist model containing only predictors unrelated to clinical management. If instrument assistance and episiotomy are also incorporated into the modelling, the estimated probability of tearing may exceed 50% in high risk individuals. Such variation highlights the need for risk adjustment when comparing hospitals with respect to their incidence of third or fourth degree perineal tears.<\/jats:p><\/jats:sec>","DOI":"10.1111\/j.1365-3016.2012.01300.x","type":"journal-article","created":{"date-parts":[[2012,5,28]],"date-time":"2012-05-28T04:21:14Z","timestamp":1338178874000},"page":"430-437","source":"Crossref","is-referenced-by-count":24,"title":["Risk Models for Benchmarking Severe Perineal Tears during Vaginal Childbirth: a Cross\u2010sectional Study of Public Hospitals in South Australia, 2002\u201308"],"prefix":"10.1111","volume":"26","author":[{"given":"Peter A.","family":"Baghurst","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Georgia","family":"Antoniou","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2012,5,28]]},"reference":[{"key":"e_1_2_6_2_2","unstructured":"Royal College of Obstetrics and Gynaecology.2007Green\u2010top Guideline No.29. The management of third\u2010 and fourth\u2010degree perineal tears (second edition March 2007).http:\/\/www.rcog.org.uk\/files\/rcog\u2010corp\/GTG2911022011.pdf[last accessed April 2012]."},{"key":"e_1_2_6_3_2","first-page":"59","volume-title":"Benchmarking Maternity Care 2006\u20132008","author":"Baghurst P","year":"2009"},{"key":"e_1_2_6_4_2","volume-title":"Towards National Indicators of Safety and Quality in Health Care","author":"Australian Institute of Health and Welfare","year":"2009"},{"key":"e_1_2_6_5_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.1991.tb15357.x"},{"key":"e_1_2_6_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.midw.2006.04.004"},{"key":"e_1_2_6_7_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-009-0959-x"},{"key":"e_1_2_6_8_2","doi-asserted-by":"crossref","unstructured":"CarroliG MigniniL.Episiotomy for vaginal birth. Cochrane Database of Systematic Reviews2009 Issue 1. Art. No.: CD000081. 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