{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T18:33:26Z","timestamp":1793385206156,"version":"4.5.0"},"reference-count":27,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2012,3,6]],"date-time":"2012-03-06T00:00:00Z","timestamp":1330992000000},"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":[[2012,5]]},"abstract":"<jats:p><jats:italic>Please cite this paper as:<\/jats:italic> Stedenfeldt M, Pirhonen J, Blix E, Wilsgaard T, Vonen B, \u00d8ian P. Episiotomy characteristics and risks for obstetric anal sphincter injuries: a case\u2010control study. BJOG 2012;119:724\u2013730.<\/jats:p><jats:p><jats:bold>Objectives\u2002<\/jats:bold> To investigate the association between the geometrical properties of episiotomy and obstetric anal sphincter injuries (OASIS) because episiotomies angled at 40\u201360\u00b0 are associated with fewer OASIS than episiotomies with more acute angles.<\/jats:p><jats:p><jats:bold>Design\u2002<\/jats:bold> Case\u2013control study.<\/jats:p><jats:p><jats:bold>Setting\u2002<\/jats:bold> University Hospital of North Norway, Troms\u00f8 and Nordland Hospital, Bod\u00f8, Norway.<\/jats:p><jats:p><jats:bold>Sample\u2002<\/jats:bold> Seventy\u2010four women who had one vaginal birth and episiotomy. Cases (<jats:italic>n<\/jats:italic>\u2003=\u200337) have sustained OASIS at birth, while controls (<jats:italic>n<\/jats:italic>\u2003=\u200337) had not. The groups were matched for instrumental delivery.<\/jats:p><jats:p><jats:bold>Methods\u2002<\/jats:bold> Two groups of women with history of only one vaginal birth were compared. Episiotomy scar was identified and photographed and relevant measures were taken. Data were analysed using conditional logistic analysis.<\/jats:p><jats:p><jats:bold>Main outcome measures\u2002<\/jats:bold> Mean episiotomy angle, length, depth, incision point.<\/jats:p><jats:p><jats:bold>Results\u2002<\/jats:bold> The risk of sustaining OASIS decreased by 70% (odds ratio [OR] 0.30; 95% CI 0.14\u20130.66) for each 5.5\u2010mm increase in episiotomy depth, decreased by 56% (OR 0.44; 95% CI 0.23\u20130.86) for each 4.5\u2010mm increase in the distance from the midline to the incision point of the episiotomy, and decreased by 75% (OR 0.25; 95% CI 0.10\u20130.61) for each 5.5\u2010mm increase in episiotomy length. Lastly, there was no difference in mean angle between groups but there was a \u201cU\u2010shaped\u201d association between angle and OASIS (OR 2.09; 95% CI 1.02\u20134.28) with an increased risk (OR 9.00; 95% CI 1.1\u201371.0) of OASIS when the angle was either smaller than 15\u00b0or &gt;60\u00b0.<\/jats:p><jats:p><jats:bold>Conclusion\u2002<\/jats:bold> The present study showed that scarred episiotomies with depth\u2003&gt;\u200316\u2003mm, length\u2003&gt;\u200317\u2003mm, incision point\u2003&gt;\u20039\u2003mm lateral of midpoint and angle range 30\u201360\u00b0 are significantly associated with less risk of OASIS. Shrinkage of tissue must be considered.<\/jats:p>","DOI":"10.1111\/j.1471-0528.2012.03293.x","type":"journal-article","created":{"date-parts":[[2012,3,6]],"date-time":"2012-03-06T10:25:34Z","timestamp":1331029534000},"page":"724-730","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":131,"title":["Episiotomy characteristics and risks for obstetric anal sphincter injuries: a case\u2010control study"],"prefix":"10.1111","volume":"119","author":[{"given":"M","family":"Stedenfeldt","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J","family":"Pirhonen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E","family":"Blix","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T","family":"Wilsgaard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B","family":"Vonen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P","family":"\u00d8ian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2012,3,6]]},"reference":[{"key":"e_1_2_11_2_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.308.6933.887"},{"key":"e_1_2_11_3_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.0001-6349.2004.00647.x"},{"key":"e_1_2_11_4_2","doi-asserted-by":"publisher","DOI":"10.1002\/uog.7512"},{"key":"e_1_2_11_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e318142cdf4"},{"key":"e_1_2_11_6_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.293.17.2141"},{"key":"e_1_2_11_7_2","first-page":"1","article-title":"The use of episiotomy in obstetrical care: a systematic review","volume":"112","author":"Viswanathan M","year":"2005","journal-title":"Evid Rep Technol Assess"},{"key":"e_1_2_11_8_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2003.03030.x"},{"key":"e_1_2_11_9_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.0730-7659.2006.00088.x"},{"key":"e_1_2_11_10_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2005.00835.x"},{"key":"e_1_2_11_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2010.03.002"},{"key":"e_1_2_11_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijgo.2007.07.022"},{"key":"e_1_2_11_13_2","first-page":"CD000081","article-title":"Episiotomy for vaginal birth","volume":"1","author":"Carroli G","year":"2009","journal-title":"Cochrane Database System Rev"},{"key":"e_1_2_11_14_2","doi-asserted-by":"publisher","DOI":"10.3109\/14767050902994820"},{"key":"e_1_2_11_15_2","doi-asserted-by":"publisher","DOI":"10.1034\/j.1600-0412.2001.080003256.x"},{"key":"e_1_2_11_16_2","doi-asserted-by":"publisher","DOI":"10.3109\/00016340903295626"},{"key":"e_1_2_11_17_2","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e3181e2f50b"},{"key":"e_1_2_11_18_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2005.00645.x"},{"key":"e_1_2_11_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijgo.2008.05.026"},{"key":"e_1_2_11_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijgo.2010.09.015"},{"key":"e_1_2_11_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijgo.2009.08.021"},{"key":"e_1_2_11_22_2","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1177\/135626229900500601","article-title":"Obstetric perinealinjury and anal incontinence","volume":"5","author":"Sultan AH","year":"1999","journal-title":"Clinical Risk"},{"key":"e_1_2_11_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ypmed.2009.10.005"},{"key":"e_1_2_11_24_2","doi-asserted-by":"publisher","DOI":"10.1136\/thx.46.6.454"},{"key":"e_1_2_11_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(86)90837-8"},{"key":"e_1_2_11_26_2","volume-title":"Foundations of Clinical Research Applications to Practice","author":"Portney LG","year":"2000"},{"key":"e_1_2_11_27_2","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e3181eda77a"},{"key":"e_1_2_11_28_2","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e31816c4402"}],"container-title":["BJOG: An International Journal of Obstetrics &amp; 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