{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T18:01:36Z","timestamp":1791223296601,"version":"4.1.0"},"reference-count":29,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2012,1,12]],"date-time":"2012-01-12T00:00:00Z","timestamp":1326326400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2012,2]]},"abstract":"<jats:p><jats:italic>Please cite this paper as:<\/jats:italic> Hirayama F, Koyanagi A, Mori R, Zhang J, Souza J, G\u00fclmezoglu A. Prevalence and risk factors for third\u2010 and fourth\u2010degree perineal lacerations during vaginal delivery: a multi\u2010country study. BJOG 2012;119:340\u2013347.<\/jats:p><jats:p><jats:bold>Objective\u2002<\/jats:bold> To investigate the prevalence and risk factors of third\u2010 and fourth\u2010degree perineal lacerations in 24, mainly developing, countries.<\/jats:p><jats:p><jats:bold>Design\u2002<\/jats:bold> Analysis using cross\u2010sectional data from the WHO Global Survey on Maternal and Perinatal Health.<\/jats:p><jats:p><jats:bold>Setting\u2002<\/jats:bold> Seven African, nine Asian and eight Latin American countries.<\/jats:p><jats:p><jats:bold>Population\u2002<\/jats:bold> Women at admission to hospital for delivery in 373 facilities between 2004 and 2008.<\/jats:p><jats:p><jats:bold>Methods\u2002<\/jats:bold> We estimated the country\u2010wise prevalence of third\u2010 and fourth\u2010degree perineal lacerations, and conducted region\u2010wise multivariate logistic regression analyses to identify its risk factors.<\/jats:p><jats:p><jats:bold>Main outcome measures\u2002<\/jats:bold> Prevalence and risk factors of third\u2010 and fourth\u2010degree perineal lacerations.<\/jats:p><jats:p><jats:bold>Results\u2002<\/jats:bold> A total of 214\u2003599 women who underwent vaginal delivery were analysed. The prevalence of third\u2010 and fourth\u2010degree perineal lacerations ranged widely across countries [from 0.1% (China, Cambodia, India) to 15.0% (Philippines)] and facilities (from null to 76.3%). After the deletion of facilities reporting no third\u2010 or fourth\u2010degree perineal lacerations, and also highly outlying facilities, the range in prevalence was 0.1% (Uganda) to 1.4% (Japan). Forceps\u2010assisted delivery, nulliparity and high birthweight were significant risk factors in all three regions. Vacuum\u2010assisted delivery was also a significant risk factor in Africa and Asia.<\/jats:p><jats:p><jats:bold>Conclusions\u2002<\/jats:bold> Misdiagnosis of third\u2010 and fourth\u2010degree perineal lacerations in developing countries may be common. Correct recognition and diagnosis may lead to timely treatment and fewer sequelae. Risk factors of third\u2010 and fourth\u2010degree perineal lacerations in developing countries were similar to those previously reported from developed countries.<\/jats:p>","DOI":"10.1111\/j.1471-0528.2011.03210.x","type":"journal-article","created":{"date-parts":[[2012,1,12]],"date-time":"2012-01-12T14:41:50Z","timestamp":1326379310000},"page":"340-347","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":77,"title":["Prevalence and risk factors for third\u2010 and fourth\u2010degree perineal lacerations during vaginal delivery: a multi\u2010country study"],"prefix":"10.1111","volume":"119","author":[{"given":"F","family":"Hirayama","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Koyanagi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R","family":"Mori","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"JP","family":"Souza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"AM","family":"G\u00fclmezoglu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2012,1,12]]},"reference":[{"key":"e_1_2_11_2_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1552-6909.2008.00259.x"},{"key":"e_1_2_11_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpobgyn.2006.12.002"},{"key":"e_1_2_11_4_2","doi-asserted-by":"publisher","DOI":"10.1080\/01443610802665090"},{"key":"e_1_2_11_5_2","doi-asserted-by":"publisher","DOI":"10.1067\/mob.2003.251"},{"key":"e_1_2_11_6_2","doi-asserted-by":"publisher","DOI":"10.3122\/jabfm.16.1.1"},{"key":"e_1_2_11_7_2","doi-asserted-by":"publisher","DOI":"10.1067\/mob.2003.547"},{"key":"e_1_2_11_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2006.06.085"},{"key":"e_1_2_11_9_2","doi-asserted-by":"publisher","DOI":"10.1080\/14767050600921307"},{"key":"e_1_2_11_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijgo.2008.02.017"},{"key":"e_1_2_11_11_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00404-006-0168-5"},{"key":"e_1_2_11_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ypmed.2009.10.005"},{"key":"e_1_2_11_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0020-7292(98)00207-0"},{"key":"e_1_2_11_14_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00404-009-1063-7"},{"key":"e_1_2_11_15_2","doi-asserted-by":"publisher","DOI":"10.1067\/mob.2000.105403"},{"key":"e_1_2_11_16_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00423-008-0441-0"},{"key":"e_1_2_11_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2009.05.020"},{"key":"e_1_2_11_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2006.10.893"},{"key":"e_1_2_11_19_2","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.06.039842"},{"key":"e_1_2_11_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(09)61870-5"},{"key":"e_1_2_11_21_2","doi-asserted-by":"publisher","DOI":"10.1186\/1742-4755-6-18"},{"key":"e_1_2_11_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthpol.2005.04.008"},{"key":"e_1_2_11_23_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1552-6909.2010.01137.x"},{"key":"e_1_2_11_24_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1467-789X.2008.00511.x"},{"key":"e_1_2_11_25_2","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e31820afaf2"},{"key":"e_1_2_11_26_2","first-page":"193","article-title":"Obstetric anal sphincter injury: how to avoid, how to repair: a literature review","volume":"55","author":"Power D","year":"2006","journal-title":"J Fam Pract"},{"key":"e_1_2_11_27_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.smj.0000243076.86803.09"},{"key":"e_1_2_11_28_2","doi-asserted-by":"publisher","DOI":"10.1067\/mob.2000.106748"},{"key":"e_1_2_11_29_2","unstructured":"FernandoRJ WilliamsAA AdamaEJ.The management of third and fourth degree perineal tears.RCOG Green\u2010top Guidelines No 292007;1\u201311."},{"key":"e_1_2_11_30_2","doi-asserted-by":"publisher","DOI":"10.1080\/01674820802547087"}],"container-title":["BJOG: An International Journal of Obstetrics &amp; 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