{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:35:51Z","timestamp":1787016951874,"version":"build-2736575974"},"reference-count":36,"publisher":"BMJ","issue":"9","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2015,7,24]]},"published-print":{"date-parts":[[2015,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>A rise in obstetric anal sphincter injuries (OASIS) has been observed and a preventive approach, originating in Finland, has been introduced in several European hospitals. The aim of this paper was to systematically evaluate the evidence behind the \u2018Finnish intervention\u2019.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A systematic review of the literature conducted according to the Preferred Reporting for Systematic Reviews and Meta-analyses (PRISMA) guidelines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome measures<\/jats:title>\n                    <jats:p>The primary outcome was OASIS. Secondary outcomes were (perinatal): Apgar scores, pH and standard base excess in the umbilical cord, and (maternal): episiotomy, intact perineum, first and second-degree perineal lacerations, duration of second stage, birth position and women's perceptions\/birth experiences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Multiple databases (Cochrane, Embase, Pubmed and SveMed) were systematically searched for studies published up to December 2014. Both randomised controlled trials and observational studies were eligible for inclusion. Studies were excluded if a full-text article was not available. Studies were evaluated by use of international reporting guidelines (eg, STROBE).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Overall, 1042 articles were screened and 65 retrieved for full-text evaluation. Seven studies, all observational and with a level of evidence at 2c or lower, were included and consistently reported a significant reduction in OASIS. All evaluated episiotomy and found a significant increase. Three studies evaluated perinatal outcomes and reported conflicting results. No study reported on other perineal outcomes, duration of the second stage, birth positions or women's perceptions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A reduction in OASIS has been contributed to the Finnish intervention in seven observational studies, all with a low level of evidence. Knowledge about the potential perinatal and maternal side effects and women's perceptions of the intervention is extremely limited and the biological mechanisms underlying the Finnish intervention are not well documented. Studies with a high level of evidence are needed to assess the effects of the intervention before implementation in clinical settings can be recommended.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2015-008346","type":"journal-article","created":{"date-parts":[[2015,9,14]],"date-time":"2015-09-14T21:19:59Z","timestamp":1442265599000},"page":"e008346","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":43,"title":["Does the Finnish intervention prevent obstetric anal sphincter injuries? A systematic review of the literature"],"prefix":"10.1136","volume":"5","author":[{"given":"Mette \u00d8stergaard","family":"Poulsen","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mia Lund","family":"Madsen","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne-Cathrine","family":"Skriver-M\u00f8ller","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlotte","family":"Overgaard","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2015,9,14]]},"reference":[{"key":"2025121411000976000_5.9.e008346.1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e318142cdf4"},{"key":"2025121411000976000_5.9.e008346.2","doi-asserted-by":"crossref","unstructured":"Aasheim V , Nilsen AB , Lukasse M , et al . Perineal techniques during the second stage of labour for reducing perineal trauma. Cochrane Database Syst Rev 2011:CD006672. doi:10.1002\/14651858.CD006672.pub2","DOI":"10.1002\/14651858.CD006672.pub2"},{"key":"2025121411000976000_5.9.e008346.3","doi-asserted-by":"crossref","first-page":"1495","DOI":"10.1007\/s00192-013-2051-9","article-title":"Outcomes and follow-up after obstetric anal sphincter injuries","volume":"24","author":"Ramalingam","year":"2013","journal-title":"Int Urogynecol J"},{"key":"2025121411000976000_5.9.e008346.4","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2393-13-59"},{"key":"2025121411000976000_5.9.e008346.5","doi-asserted-by":"publisher","DOI":"10.1080\/j.1600-0412.1998.771005.x"},{"key":"2025121411000976000_5.9.e008346.6","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/j.ejogrb.2009.04.033","article-title":"Changing incidence of anal sphincter tears in four Nordic countries through the last decades","volume":"146","author":"Laine","year":"2009","journal-title":"Eur J Obs Gynecol Reprod Biol"},{"key":"2025121411000976000_5.9.e008346.7","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1111\/aogs.12024","article-title":"Are obstetric anal sphincter ruptures preventable?\u2014large and consistent rupture rate variations between the Nordic countries and between delivery units in Norway","volume":"92","author":"Laine","year":"2013","journal-title":"Acta Obstet Gynecol Scand"},{"key":"2025121411000976000_5.9.e008346.8","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2012-001649"},{"key":"2025121411000976000_5.9.e008346.9","doi-asserted-by":"crossref","first-page":"926","DOI":"10.1111\/j.1471-0528.2000.tb11093.x","article-title":"Anal sphincter tears: prospective study of obstetric risk factors","volume":"107","author":"Samuelsson","year":"2000","journal-title":"BJOG"},{"key":"2025121411000976000_5.9.e008346.10","first-page":"70","article-title":"Experiences of expert midwives in a training program aimed at decreasing perineal tears","volume":"3","author":"Pirhonen","year":"2011","journal-title":"Int J Nurs Midwifery"},{"key":"2025121411000976000_5.9.e008346.11","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1016\/S0266-6138(97)80006-X","article-title":"Reducing perineal trauma: implications of flexion and extension of the fetal head during birth","volume":"13","author":"Myrfield","year":"1997","journal-title":"Midwifery"},{"key":"2025121411000976000_5.9.e008346.12","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e318182a8d3"},{"key":"2025121411000976000_5.9.e008346.13","doi-asserted-by":"crossref","first-page":"2352","DOI":"10.4045\/tidsskr.11.0643","article-title":"Use of manual techniques for perineal support in Norwegian maternity departments","volume":"131","author":"Fretheim","year":"2011","journal-title":"Tidsskr Nor Legeforen"},{"key":"2025121411000976000_5.9.e008346.14","doi-asserted-by":"crossref","first-page":"901","DOI":"10.1097\/AOG.0b013e3181eda77a","article-title":"A multicenter interventional program to reduce the incidence of anal sphincter tears","volume":"116","author":"Hals","year":"2010","journal-title":"Obstet Gynecol"},{"key":"2025121411000976000_5.9.e008346.15","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.midw.2014.09.004","article-title":"Severe perineal trauma is rising, but let us not overreact","volume":"31","author":"Dahlen","year":"2015","journal-title":"Midwifery"},{"key":"2025121411000976000_5.9.e008346.16","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1016\/j.midw.2014.10.004","article-title":"Hands-poised technique: The future technique for perineal management of second stage of labour? A modified systematic literature review","volume":"31","author":"Petrocnik","year":"2015","journal-title":"Midwifery"},{"key":"2025121411000976000_5.9.e008346.17","unstructured":"Maimburg RD . Fagligt indstik: Evidensbaseret klinik ved caputs forl\u00f8sning. Tidsskr Jordem\u00f8dre 2015."},{"key":"2025121411000976000_5.9.e008346.18","unstructured":"Rasmussen OB , Gommesen D , Christiansen AG , et al . Kommentarer til artiklen \u201cEvidensbaseret klinik ved caputs forl\u00f8sning\u201d, Tidsskrift for Jordem\u00f8dre 1\/2015. Tidsskr Jordem\u00f8dre 2015;2."},{"key":"2025121411000976000_5.9.e008346.19","doi-asserted-by":"crossref","first-page":"4","DOI":"10.4045\/tidsskr.12.1460","article-title":"F\u00f8dselsrifter\u2014vitenskapsteori og klinisk praksis","volume":"133","author":"Fretheim","year":"2013","journal-title":"Tidsskr Nor Legeforen"},{"key":"2025121411000976000_5.9.e008346.20","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2004.05.044"},{"key":"2025121411000976000_5.9.e008346.21","first-page":"CD002006","article-title":"Position in the second stage of labour for women without epidural anaesthesia","volume":"5","author":"Gupta","year":"2012","journal-title":"Cochrane Database Syst Rev"},{"key":"2025121411000976000_5.9.e008346.22","doi-asserted-by":"publisher","DOI":"10.1016\/S0029-7844(99)00560-8"},{"key":"2025121411000976000_5.9.e008346.23","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.b2700"},{"key":"2025121411000976000_5.9.e008346.24","doi-asserted-by":"crossref","first-page":"A12","DOI":"10.7326\/ACPJC-1995-123-3-A12","article-title":"The well-built clinical question: a key to evidence-based decisions","volume":"123","author":"Richardson","year":"1995","journal-title":"ACP J Club"},{"key":"2025121411000976000_5.9.e008346.25","doi-asserted-by":"crossref","first-page":"1495","DOI":"10.1016\/j.ijsu.2014.07.013","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for reporting observational studies","volume":"12","author":"Von Elm","year":"2014","journal-title":"Int J Surg"},{"key":"2025121411000976000_5.9.e008346.26","unstructured":"National Institute for Health and Clinical Excellence. London: Methods for development of NICE public health guidance, 2006. http:\/\/www.nice.org.uk\/article\/pmg4\/resources\/non-guidance-methods-for-the- development-of-nice-public-health-guidance-third-edition-pdf (accessed 23 May 2015)."},{"key":"2025121411000976000_5.9.e008346.27","unstructured":"OCEBM Levels of Evidence Working Group. The Oxford 2009 Levels of Evidence. Oxford Centre for Evidence-Based Medicine. http:\/\/www.cebm.net\/index.aspx?o=5653 (accessed 23 may 2015)."},{"key":"2025121411000976000_5.9.e008346.28","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e31816c4402"},{"key":"2025121411000976000_5.9.e008346.29","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1111\/1471-0528.12274","article-title":"Risk factors for obstetric anal sphincter injury after a successful multicentre interventional programme","volume":"121","author":"Stedenfeldt","year":"2014","journal-title":"BJOG"},{"key":"2025121411000976000_5.9.e008346.30","doi-asserted-by":"publisher","DOI":"10.1037\/0021-9010.69.2.334"},{"key":"2025121411000976000_5.9.e008346.31","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1111\/j.1479-828X.2007.00739.x","article-title":"The role of maternal age and episiotomy in the risk of anal sphincter tears during childbirth","volume":"47","author":"Gerdin","year":"2007","journal-title":"Aust N Z J Obstet Gynaecol"},{"key":"2025121411000976000_5.9.e008346.32","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.308.6933.887"},{"key":"2025121411000976000_5.9.e008346.33","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9378(94)90070-1"},{"key":"2025121411000976000_5.9.e008346.34","doi-asserted-by":"crossref","first-page":"1370","DOI":"10.1111\/j.1471-0528.2012.03455.x","article-title":"Vacuum-assisted deliveries and the risk of obstetric anal sphincter injuries-a retrospective register-based study in Finland","volume":"119","author":"R\u00e4is\u00e4nen","year":"2012","journal-title":"BJOG"},{"key":"2025121411000976000_5.9.e008346.35","doi-asserted-by":"crossref","first-page":"672","DOI":"10.1111\/1471-0528.13263","article-title":"Dyspareunia and childbirth: a prospective cohort study","volume":"122","author":"McDonald","year":"2015","journal-title":"BJOG"},{"key":"2025121411000976000_5.9.e008346.36","doi-asserted-by":"crossref","first-page":"2640","DOI":"10.1111\/j.1365-2648.2010.05428.x","article-title":"Effects of perineal trauma on postpartum sexual function","volume":"66","author":"Rathfisch","year":"2010","journal-title":"J Adv Nurs"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2015-008346","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,14]],"date-time":"2025-12-14T19:00:21Z","timestamp":1765738821000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2015-008346"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,9]]},"references-count":36,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2015,9,14]]},"published-print":{"date-parts":[[2015,9]]}},"alternative-id":["10.1136\/bmjopen-2015-008346"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2015-008346","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,9]]}}}