{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,20]],"date-time":"2025-09-20T06:54:29Z","timestamp":1758351269293,"version":"3.44.0"},"reference-count":68,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2025,9,18]],"date-time":"2025-09-18T00:00:00Z","timestamp":1758153600000},"content-version":"unspecified","delay-in-days":17,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100007709","name":"Michigan State University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007709","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,9,4]]},"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Perineal trauma is one of the most common complications of childbirth, impacting approximately 9 out of 10\u2009women who undergo a vaginal delivery. Perineal trauma is a public health issue leading to increased maternal morbidity and decreased quality of life. Although race is being studied as a potential risk factor and predictor of perineal trauma, other contributing factors like racism and social determinants of health have not been adequately studied in the same context. We set out to synthesise the available peer-reviewed evidence evaluating the prognostic association between race and perineal trauma.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and analysis<\/jats:title>\n                  <jats:p>This systematic review and meta-analysis adheres to the PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols) and PROGRESS (Prognosis Research Strategy) guidelines and is registered with PROSPERO. The review explores the association between racial status (non-Hispanic white vs non-white) and perineal birth trauma using the PECOTS (Population, Intervention\/Exposure, Comparator, Outcome, Timing and Setting) framework. We will search PubMed, CINAHL, Web of Science and Embase. Peer-reviewed observational studies will be included. Data extraction and screening will be done in duplicate. Analyses will use random-effects models in R, reporting both unadjusted and adjusted risk differences. Risk of bias will be assessed using ROBINS-I (Risk of Bias in Non-randomised Studies of Interventions). Heterogeneity and certainty of evidence will be evaluated using I\u00b2 and GRADE (Grading of Recommendations Assessment, Development and Evaluation), respectively.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Ethics and dissemination<\/jats:title>\n                  <jats:p>This is a systematic review based on previously published data, and therefore ethical approval is not required. The findings of this review will be disseminated through publication in a peer-reviewed journal and presented at academic conferences.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>PROSPERO registration number<\/jats:title>\n                  <jats:p>CRD42025590093.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-105272","type":"journal-article","created":{"date-parts":[[2025,9,19]],"date-time":"2025-09-19T06:20:38Z","timestamp":1758262838000},"page":"e105272","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Evaluating the prognostic association between race and perineal trauma: a systematic review protocol"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6480-7263","authenticated-orcid":false,"given":"Haifa Hussein","family":"Almalki","sequence":"first","affiliation":[{"name":"College of Nursing, Michigan State University, East Lansing, Michigan, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabrice I","family":"Mowbray","sequence":"additional","affiliation":[{"name":"College of Nursing, Michigan State University, East Lansing, Michigan, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6311-9709","authenticated-orcid":false,"given":"Susan","family":"Buchholz","sequence":"additional","affiliation":[{"name":"College of Nursing, Michigan State University, East Lansing, Michigan, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ibtihal","family":"Alnaimi","sequence":"additional","affiliation":[{"name":"College of Nursing, Michigan State University, East Lansing, Michigan, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0242-6561","authenticated-orcid":false,"given":"Emma C","family":"Schlegel","sequence":"additional","affiliation":[{"name":"College of Nursing, Michigan State University, East Lansing, Michigan, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Janis","family":"Miller","sequence":"additional","affiliation":[{"name":"University of Michigan, Ann Arbor, Michigan, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9249-4981","authenticated-orcid":false,"given":"Jessica","family":"Sender","sequence":"additional","affiliation":[{"name":"College of Nursing, Michigan State University, East Lansing, Michigan, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,9,18]]},"reference":[{"key":"2025091823201793000_15.9.e105272.1","doi-asserted-by":"crossref","first-page":"S991","DOI":"10.1016\/j.ajog.2022.06.021","article-title":"The prevention of perineal trauma during vaginal birth","volume":"230","author":"Okeahialam","year":"2024","journal-title":"Am J Obstet Gynecol"},{"key":"2025091823201793000_15.9.e105272.2","article-title":"Methods of repair for obstetric anal sphincter injury","volume":"2013","author":"Fernando","year":"2013","journal-title":"Cochrane Database Syst Rev"},{"key":"2025091823201793000_15.9.e105272.3","unstructured":"RCOG . 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