{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T01:50:52Z","timestamp":1784685052172,"version":"3.55.0"},"reference-count":27,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,8,18]],"date-time":"2021-08-18T00:00:00Z","timestamp":1629244800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,8,18]],"date-time":"2021-08-18T00:00:00Z","timestamp":1629244800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Pregnancy Childbirth"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Obstetric anal sphincter injury (OASI) is a debilitating complication of vaginal delivery which has yet to receive ample attention in adolescents. The aim of this study was to describe risk for OASI in adolescent mothers compared to adults. We further attempted to compare risk factors for OASI between these two age groups.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>We performed a retrospective cohort study between 2003 and 2019. Primiparous women who delivered vaginally, 21\u2009years and younger were compared to women ages 26\u201335. Excluded were preterm, multifetal, non-vertex, cesarean deliveries as well as intrauterine fetal death. Rate of OASI as well as obstetric and labor characteristics of women with OASI, were compared between groups. Finally, risk factors were assessed for each group separately. Univariate and multivariate logistic regression model were performed.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Final analysis was performed on 5113 nulliparous adolescents and 13,845 nulliparous in the 26\u201335 age group. Allocation to study groups was according to OASI \u2013 Sixty-seven adolescents (1.3%) had a 3rd or 4th degree perineal tear and were defined as the OASI group, while 5046 patients (98.7%) did not have such a tear. In the adult group, 199 out of 13,845 patients (1.4%) were diagnosed with OASI. Occurrence of OASI did not differ between groups (<jats:italic>p<\/jats:italic>\u2009=\u20090.510). Comparison of women with OASI in the adolescent group vs. adult group found differences with regard to operative vaginal delivery, (20.9% vs. 36.2%, respectively; <jats:italic>p<\/jats:italic>\u2009=\u20090.023) and meconium stained amniotic fluid (9.1% vs. 21.3%, respectively; <jats:italic>p<\/jats:italic>\u2009=\u20090.027).<\/jats:p>\n                <jats:p>Following multivariate analysis the only parameter independently associated with OASI in the adolescent age group was head circumference\u2009\u2265\u200990th percentile with an adjusted odds ratio of 3.08 (CI 1.48\u20136.38, <jats:italic>p<\/jats:italic>\u2009=\u20090.003). In the adult group the similar analysis revealed operative vaginal delivery (OR\u2009=\u20092.44, CI 1.72\u20133.47, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) and a birthweight\u226590th percentile (OR\u2009=\u20092.23, CI 1.19\u20134.18, <jats:italic>p<\/jats:italic>\u2009=\u20090.012) to be independent risk factors for OASI.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Adolescents have similar risk for OASI compared to adults but differ in risk factors leading to OASI. Head circumference\u2009\u2265\u200990th percentile was found to be associated with OASI in this age group.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12884-021-04045-4","type":"journal-article","created":{"date-parts":[[2021,8,18]],"date-time":"2021-08-18T11:04:43Z","timestamp":1629284683000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Obstetric anal sphincter injury in adolescent mothers"],"prefix":"10.1186","volume":"21","author":[{"given":"Henry H.","family":"Chill","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michal","family":"Lipschuetz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eyal","family":"Atias","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tzvika","family":"Shimonovitz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Shveiky","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gilad","family":"Karavani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,8,18]]},"reference":[{"key":"4045_CR1","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1016\/S0020-7292(02)00240-0","volume":"79","author":"PC Chandra","year":"2002","unstructured":"Chandra PC, Schiavello HJ, Ravi B, et al. Pregnancy outcomes in urban teenagers. Int J Gynaecol Obstet. 2002;79:117\u201322.","journal-title":"Int J Gynaecol Obstet"},{"issue":"3","key":"4045_CR2","doi-asserted-by":"publisher","first-page":"174","DOI":"10.1111\/j.1740-8709.2007.00097.x","volume":"3","author":"CP Stewart","year":"2007","unstructured":"Stewart CP, Katz J, Khatry SK, et al. Preterm delivery but not intrauterine growth restriction is associated with young maternal age among primiparae in rural Nepal. Matern Child Nutr. 2007;3(3):174\u201385.","journal-title":"Matern Child Nutr"},{"issue":"12","key":"4045_CR3","first-page":"1","volume":"64","author":"BE Hamilton","year":"2015","unstructured":"Hamilton BE, Martin JA, Osterman MJK, et al. Births: final data for 2014. Natl Vital Stat Rep. 2015;64(12):1\u201364.","journal-title":"Natl Vital Stat Rep"},{"key":"4045_CR4","doi-asserted-by":"publisher","first-page":"g5887","DOI":"10.1136\/bmj.g5887","volume":"349","author":"FP McCarthy","year":"2014","unstructured":"McCarthy FP, O\u2019Brien U, Kenny LC. The management of teenage pregnancy. BMJ. 2014;349:g5887.","journal-title":"BMJ."},{"issue":"6","key":"4045_CR5","first-page":"333","volume":"5","author":"RL Perry","year":"1996","unstructured":"Perry RL, Mannino B, Hediger ML, Scholl TO. Pregnancy in early adolescence: are there obstetric risks? J Matern Fetal Med. 1996;5(6):333\u20139.","journal-title":"J Matern Fetal Med"},{"issue":"4","key":"4045_CR6","doi-asserted-by":"publisher","first-page":"618","DOI":"10.1590\/S1679-45082015RW3127","volume":"13","author":"WF Azevedo","year":"2015","unstructured":"Azevedo WF, Diniz MB, Fonseca ES, Azevedo LM, Evangelista CB. Complications in adolescent pregnancy:systematic review of the literature. Einstein (Sao Paulo). 2015;13(4):618\u201326.","journal-title":"Einstein (Sao Paulo)"},{"issue":"2","key":"4045_CR7","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1016\/j.jpag.2015.08.006","volume":"29","author":"T Kawakita","year":"2016","unstructured":"Kawakita T, Wilson K, Grantz KL, et al. Adverse maternal and neonatal outcomes in adolescent pregnancy. J Pediatr Adolesc Gynecol. 2016;29(2):130\u20136.","journal-title":"J Pediatr Adolesc Gynecol"},{"issue":"6","key":"4045_CR8","doi-asserted-by":"publisher","first-page":"345","DOI":"10.1097\/SPV.0b013e3181fe2a4c","volume":"16","author":"D Patterson","year":"2010","unstructured":"Patterson D, Hundley AF. Risk factors for perineal lacerations in teen deliveries. Female Pelvic Med Reconstr Surg. 2010;16(6):345\u20138.","journal-title":"Female Pelvic Med Reconstr Surg"},{"issue":"15","key":"4045_CR9","doi-asserted-by":"publisher","first-page":"1554","DOI":"10.3109\/14767058.2013.794212","volume":"26","author":"A Aviram","year":"2013","unstructured":"Aviram A, Raban O, Melamed N, et al. The association between young maternal age and pregnancy outcome. J Matern Fetal Neonatal Med. 2013;26(15):1554\u20138.","journal-title":"J Matern Fetal Neonatal Med"},{"key":"4045_CR10","doi-asserted-by":"publisher","first-page":"270","DOI":"10.1186\/s12884-015-0703-0","volume":"15","author":"J Ott","year":"2015","unstructured":"Ott J, Gritsch E, Pils S, et al. A retrospective study on perineal lacerations in vaginal delivery and the individual performance of experienced midwives. BMC Pregnancy Childbirth. 2015;15:270.","journal-title":"BMC Pregnancy Childbirth"},{"key":"4045_CR11","doi-asserted-by":"publisher","first-page":"266","DOI":"10.4236\/ojog.2014.46043","volume":"4","author":"LK Low","year":"2014","unstructured":"Low LK, Zielinski R, Tao Y, Galecki A, Brandon CJ, Miller JM. Predicting birth-related levator ani tear severity in primiparous women: evaluating maternal recovery from labor and delivery (EMRLD study). Open J Obstet Gynecol. 2014;4:266\u201378.","journal-title":"Open J Obstet Gynecol"},{"key":"4045_CR12","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1111\/j.0730-7659.2006.00088.x","volume":"33","author":"V Andrews","year":"2006","unstructured":"Andrews V, Sultan AH, Thakar R, Jones PW. Risk factors for obstetric anal sphincter injury: a prospective study. Birth. 2006;33:117\u201322.","journal-title":"Birth."},{"key":"4045_CR13","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1097\/AOG.0b013e3181e2f50b","volume":"116","author":"E Baghestan","year":"2010","unstructured":"Baghestan E, Irgens LM, Bordahl PE, Rasmussen S. Trends in risk factors for obstetric anal sphincter injuries in Norway. Obstet Gynecol. 2010;116:25\u201334.","journal-title":"Obstet Gynecol"},{"key":"4045_CR14","doi-asserted-by":"crossref","unstructured":"Lipschuetz M, Cohen SM, Ein-Mor E, et al. A large head circumference is more strongly associated with unplanned cesarean or instrumental delivery and neonatal complications than high birthweight. Am J Obstet Gynecol. 2015;213(6):833. e831\u2013833 e812.","DOI":"10.1016\/j.ajog.2015.07.045"},{"key":"4045_CR15","doi-asserted-by":"crossref","unstructured":"Lipschuetz M, Cohen SM, Israel A, et al. Sonographic large fetal head circumference and risk of cesarean delivery. Am J Obstet Gynecol. 2018;218(3):339. e331\u2013339 e337.","DOI":"10.1016\/j.ajog.2017.12.230"},{"issue":"20","key":"4045_CR16","doi-asserted-by":"publisher","first-page":"3325","DOI":"10.1080\/14767058.2018.1463364","volume":"32","author":"D Kabiri","year":"2019","unstructured":"Kabiri D, Lipschuetz M, Cohen SM, et al. Vacuum extraction failure is associated with a large head circumference. J Matern Fetal Neonatal Med. 2019;32(20):3325\u201330.","journal-title":"J Matern Fetal Neonatal Med"},{"issue":"1","key":"4045_CR17","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1159\/000478010","volume":"44","author":"O Yagel","year":"2018","unstructured":"Yagel O, Cohen SM, Lipschuetz M, et al. Higher rates of operative delivery and maternal and neonatal complications in persistent occiput posterior position with a large head circumference: a retrospective cohort study. Fetal Diagn Ther. 2018;44(1):51\u20138.","journal-title":"Fetal Diagn Ther"},{"issue":"6","key":"4045_CR18","doi-asserted-by":"publisher","first-page":"700","DOI":"10.1002\/uog.13325","volume":"44","author":"M Lipschuetz","year":"2014","unstructured":"Lipschuetz M, Valsky DV, Shick-Naveh L, et al. Sonographic finding of postpartum levator ani muscle injury correlates with pelvic floor clinical examination. Ultrasound Obstet Gynecol. 2014;44(6):700\u20133.","journal-title":"Ultrasound Obstet Gynecol"},{"issue":"6","key":"4045_CR19","doi-asserted-by":"publisher","first-page":"724","DOI":"10.1002\/uog.14840","volume":"46","author":"DV Valsky","year":"2015","unstructured":"Valsky DV, Lipschuetz M, Cohen SM, et al. Persistence of levator ani sonographic defect detected by three-dimensional transperineal sonography in primiparous women. Ultrasound Obstet Gynecol. 2015;46(6):724\u20139.","journal-title":"Ultrasound Obstet Gynecol"},{"issue":"1","key":"4045_CR20","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1002\/uog.10072","volume":"39","author":"DV Valsky","year":"2012","unstructured":"Valsky DV, Cohen SM, Lipschuetz M, Hochner-Celnikier D, Yagel S. Three-dimensional transperineal ultrasound findings associated with anal incontinence after intrapartum sphincter tears in primiparous women. Ultrasound Obstet Gynecol. 2012;39(1):83\u201390.","journal-title":"Ultrasound Obstet Gynecol"},{"key":"4045_CR21","unstructured":"US Department of Health and Human Services Food and Drug Administration. Guidance for Industry and FDA Staff: Pediatric Expertise for Advisory Panels. Rockville, MD: US Department of Health and Human Services, Food and Drug Administration, Center for Devices and Radiological Health; 2003. Available at: www.fda.gov\/downloads\/MedicalDevices\/DeviceRegulationandGuidance\/GuidanceDocuments\/ucm082188.pdf. Accessed 15 Mar 2021."},{"key":"4045_CR22","volume-title":"Bright futures: guidelines for the health supervision of infants, children, and adolescents","year":"2008","unstructured":"Hagan JF Jr, Shaw JS, Duncan P, editors. Bright futures: guidelines for the health supervision of infants, children, and adolescents. 3rd ed. Elk Grove Village: American Academy of Pediatrics; 2008.","edition":"3"},{"key":"4045_CR23","doi-asserted-by":"crossref","unstructured":"Society for Adolescent Health and Medicine. Young Adult Health and Well-Being: A Position Statement of the Society for Adolescent Health and Medicine J Adolesc Health. 2017;60(6):758\u2013759.","DOI":"10.1016\/j.jadohealth.2017.03.021"},{"key":"4045_CR24","doi-asserted-by":"crossref","unstructured":"Committee on Practice Bulletins-Obstetrics. ACOG Practice Bulletin No. 198: prevention and management of obstetric lacerations at vaginal delivery. Obstet Gynecol 2018;132(3):e87-e102.","DOI":"10.1097\/AOG.0000000000002841"},{"key":"4045_CR25","doi-asserted-by":"publisher","first-page":"627","DOI":"10.1097\/AOG.0b013e31820afaf2","volume":"117","author":"HJ Landy","year":"2011","unstructured":"Landy HJ, Laughon SK, Bailit JL, et al. For the consortium on safe labor. Characteristics associated with severe perineal and cervical lacerations during vaginal delivery. Obstet Gynecol. 2011;117:627\u201335.","journal-title":"Obstet Gynecol"},{"key":"4045_CR26","doi-asserted-by":"crossref","unstructured":"Torvie AJ, Callegari LS, Schiff MA, et al: Labor and delivery outcomes among young adolescents. Am J Obstet Gynecol. 2015; 213(1):95.e1\u20138.","DOI":"10.1016\/j.ajog.2015.04.024"},{"issue":"2","key":"4045_CR27","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1016\/j.jpag.2018.11.004","volume":"32","author":"D Shveiky","year":"2019","unstructured":"Shveiky D, Patchen L, Chill HH, Pehlivanova M, Landy HJ. Prevalence and location of obstetric lacerations in adolescent mothers. J Pediatr Adolesc Gynecol. 2019;32(2):135\u20138.","journal-title":"J Pediatr Adolesc Gynecol"}],"container-title":["BMC Pregnancy and Childbirth"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12884-021-04045-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12884-021-04045-4\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12884-021-04045-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,8,18]],"date-time":"2021-08-18T11:10:25Z","timestamp":1629285025000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcpregnancychildbirth.biomedcentral.com\/articles\/10.1186\/s12884-021-04045-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8,18]]},"references-count":27,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["4045"],"URL":"https:\/\/doi.org\/10.1186\/s12884-021-04045-4","relation":{},"ISSN":["1471-2393"],"issn-type":[{"value":"1471-2393","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8,18]]},"assertion":[{"value":"24 April 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 August 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 August 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was approved by the institutional ethical review board of Hadassah Medical Center, IRB#0348\u201320-HMO. All methods were performed in accordance with the relevant guidelines and regulations of the institutional ethical review board and in accordance with the Declaration of Helsinki. Informed consent was not required following a waiver granted from the institutional ethical review board.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"564"}}