{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T05:10:54Z","timestamp":1772169054183,"version":"3.50.1"},"update-to":[{"DOI":"10.12688\/hrbopenres.13656.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2023,10,10]],"date-time":"2023-10-10T00:00:00Z","timestamp":1696896000000}}],"reference-count":22,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2023,10,10]],"date-time":"2023-10-10T00:00:00Z","timestamp":1696896000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010414","name":"Health Research Board","doi-asserted-by":"publisher","award":["SDAP-2019-017"],"award-info":[{"award-number":["SDAP-2019-017"]}],"id":[{"id":"10.13039\/100010414","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["hrbopenresearch.org"],"crossmark-restriction":false},"short-container-title":["HRB Open Res"],"abstract":"<ns4:p>\n                    <ns4:bold>Background:<\/ns4:bold>\n                    Perineal trauma is a common complication of childbirth and can have serious impacts on long-term health. Few studies have examined the combined effect of multiple risk factors. We developed and internally validated a risk prediction model to predict third and fourth degree perineal tears using data from a general obstetric population.\n                  <\/ns4:p>\n                  <ns4:p>\n                    <ns4:bold>Methods:<\/ns4:bold>\n                    Risk prediction model using data from all singleton vaginal deliveries at Cork University Maternity Hospital (CUMH), Ireland during 2019 and 2020.\n                    <ns4:bold\/>\n                    Third\/fourth degree tears were diagnosed by an obstetrician or midwife at time of birth and defined as tears that extended into the anal sphincter complex or involved both the anal sphincter complex and anorectal mucosa. We used univariable and multivariable logistic regression with backward stepwise selection to develop the models. Candidate predictors included infant sex, maternal age, maternal body mass index, parity, mode of delivery, birthweight, post-term delivery, induction of labour and public\/private antenatal care. We used the receiver operating characteristic\u00a0(ROC) curve C-statistic to assess discrimination, and bootstrapping techniques were used to assess internal validation.\n                  <\/ns4:p>\n                  <ns4:p>\n                    <ns4:bold>Results:<\/ns4:bold>\n                    Of 8,403 singleton vaginal deliveries, 8,367 (99.54%) had complete data on predictors for model development. A total of 128 women (1.53%) had a third\/fourth degree tear.\n                    <ns4:bold\/>\n                    Three variables remained in the final model: nulliparity, mode of delivery (specifically forceps delivery or ventouse delivery) and increasing birthweight (per 100 gram increase) (C-statistic: 0.75, 95% CI: 0.71, 0.79). We developed a nomogram to calculate individualised risk of third\/fourth degree tears using these predictors. Bootstrapping indicated good internal performance.\n                  <\/ns4:p>\n                  <ns4:p>\n                    <ns4:bold>Conclusions:<\/ns4:bold>\n                    Use of our nomogram can provide an individualised risk assessment of third\/fourth degree tears and potentially aid counselling of women on their potential risk.\n                  <\/ns4:p>","DOI":"10.12688\/hrbopenres.13656.2","type":"journal-article","created":{"date-parts":[[2023,10,10]],"date-time":"2023-10-10T03:10:07Z","timestamp":1696907407000},"page":"79","update-policy":"https:\/\/doi.org\/10.12688\/hrbopenres.crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Predicting perineal trauma during childbirth using data from a general obstetric population"],"prefix":"10.12688","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6722-0484","authenticated-orcid":false,"given":"Gillian M.","family":"Maher","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1916-2347","authenticated-orcid":false,"given":"Laura J.","family":"O'Byrne","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joye","family":"McKernan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1201-7136","authenticated-orcid":false,"given":"Paul","family":"Corcoran","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0247-523X","authenticated-orcid":false,"given":"Richard A.","family":"Greene","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7499-9406","authenticated-orcid":false,"given":"Ali S.","family":"Khashan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fergus P.","family":"McCarthy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2560","published-online":{"date-parts":[[2023,10,10]]},"reference":[{"key":"ref-1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-020-03447-0","article-title":"Risk factors for perineal and vaginal tears in primiparous women - the prospective POPRACT-cohort study.","volume":"20","author":"M Jansson","year":"2020","journal-title":"BMC Pregnancy Childbirth."},{"key":"ref-2","article-title":"Perineal Lacerations.","author":"C Ramar","year":"2021"},{"key":"ref-3","article-title":"Care of a third- or fourth-degree tear that occurred during childbirth (also known as obstetric anal sphincter injury OASI).","year":"2019"},{"key":"ref-4","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0215180","article-title":"The impact of third- or fourth-degree perineal tears on the second pregnancy: A cohort study of 182,445 Scottish women.","volume":"14","author":"A Woolner","year":"2019","journal-title":"PLoS One."},{"key":"ref-5","doi-asserted-by":"publisher","first-page":"368-74","DOI":"10.1002\/uog.7512","article-title":"Outcome of primary repair of obstetric anal sphincter injuries (OASIS): does the grade of tear matter?","volume":"36","author":"A Roos","year":"2010","journal-title":"Ultrasound Obstet Gynecol."},{"key":"ref-6","doi-asserted-by":"publisher","first-page":"367-74","DOI":"10.1007\/s00192-016-3125-2","article-title":"An obstetric sphincter injury risk identification system (OSIRIS): is this a clinically useful tool?","volume":"28","author":"S Webb","year":"2017","journal-title":"Int Urogynecol J."},{"key":"ref-7","article-title":"Maternal & Newborn Clinical Management 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Luchristt","year":"2022","journal-title":"BJOG."},{"key":"ref-16","doi-asserted-by":"publisher","first-page":"62-9","DOI":"10.1111\/j.1471-0528.2011.03150.x","article-title":"Risk of recurrence and subsequent delivery after obstetric anal sphincter injuries.","volume":"119","author":"E Baghestan","year":"2012","journal-title":"BJOG."},{"key":"ref-17","doi-asserted-by":"publisher","first-page":"831-5","DOI":"10.1097\/01.AOG.0000154160.87325.77","article-title":"Risk of recurrence of anal sphincter lacerations.","volume":"105","author":"V Dandolu","year":"2005","journal-title":"Obstet Gynecol."},{"key":"ref-18","doi-asserted-by":"publisher","first-page":"307-13","DOI":"10.1097\/01.AOG.0000151114.35498.e9","article-title":"Recurrent risk of anal sphincter laceration among women with vaginal deliveries.","volume":"105","author":"A Spydslaug","year":"2005","journal-title":"Obstet Gynecol."},{"key":"ref-19","doi-asserted-by":"publisher","first-page":"849-57","DOI":"10.1007\/s00192-015-2893-4","article-title":"Risk factors for recurrent obstetric anal sphincter injury (rOASI): a systematic review and meta-analysis.","volume":"27","author":"S Jha","year":"2016","journal-title":"Int Urogynecol J."},{"key":"ref-20","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.c2442","article-title":"An independent and external validation of QRISK2 cardiovascular disease risk score: a prospective open cohort study.","volume":"340","author":"G Collins","year":"2010","journal-title":"BMJ."},{"key":"ref-21","doi-asserted-by":"publisher","first-page":"642-7","DOI":"10.1002\/uog.17306","article-title":"Overdiagnosis and rising rate of obstetric anal sphincter injuries (OASIS): time for reappraisal.","volume":"50","author":"D Sioutis","year":"2017","journal-title":"Ultrasound Obstet Gynecol."},{"key":"ref-22","article-title":"Irish Maternity Indicator System: National Report 2020."},{"key":"ref-23","doi-asserted-by":"publisher","first-page":"724-30","DOI":"10.1111\/j.1471-0528.2012.03293.x","article-title":"Episiotomy characteristics and risks for obstetric anal sphincter injuries: a case-control study.","volume":"119","author":"M Stedenfeldt","year":"2012","journal-title":"BJOG."}],"container-title":["HRB Open Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/hrbopenresearch.org\/articles\/5-79\/v2\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/hrbopenresearch.org\/articles\/5-79\/v2\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/hrbopenresearch.org\/articles\/5-79\/v2\/iparadigms","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,3]],"date-time":"2023-11-03T07:05:14Z","timestamp":1698995114000},"score":1,"resource":{"primary":{"URL":"https:\/\/hrbopenresearch.org\/articles\/5-79\/v2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,10]]},"references-count":22,"URL":"https:\/\/doi.org\/10.12688\/hrbopenres.13656.2","relation":{"has-review":[{"id-type":"doi","id":"10.21956\/hrbopenres.15117.r36502","asserted-by":"subject"},{"id-type":"doi","id":"10.21956\/hrbopenres.15117.r36502","asserted-by":"object"}]},"ISSN":["2515-4826"],"issn-type":[{"value":"2515-4826","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10,10]]},"assertion":[{"value":"Indexed","URL":"https:\/\/hrbopenresearch.org\/articles\/5-79\/v2#article-reports","order":0,"name":"referee-status","label":"Referee status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.21956\/hrbopenres.14934.r35280, Jouko Pirhonen, University Hospital of North Norway, Troms\u00f8, 02 Aug 2023, version 1, 1 approved, 1 approved with reservations","URL":"https:\/\/hrbopenresearch.org\/articles\/5-79\/v1#referee-response-35280","order":0,"name":"referee-response-35280","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Gillian Maher<\/b>; \n<i>Posted: 27 Sep 2023<\/i>; Dear Prof Jouko Pirhonen,  We thank you for your helpful review of our manuscript entitled \n<i>\u201cPredicting perineal trauma during childbirth using data from a general obstetric population\u201d<\/i>. Please find below an itemized reply addressing each comment in your Reviewer\u2019s Report.  \n<i>1. <\/i>\n<i>The greatest limitation of this register study is the database used. For example, the authors describe the used episiotomy (mediolateral) nicely. However, an information if the episiotomy was cut correctly is missing. The authors could read the study from Stedenfeldt et al. Episiotomy characteristics and risks for obstetric anal sphincter injuries: a case-control study. BJOG 2012;119:724\u201373 for their future research.<\/i>  &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; We thank you for your positive comment regarding the description of episiotomy in our study and for drawing our attention to the Stedenfeldt et al study. As we have outlined in our manuscript, episiotomy was defined as a right mediolateral incision (i.e., a cut made by the doctor or midwife during childbirth that begins in the middle of the vaginal opening and extends down toward the buttocks at a 45-degree angle). However, we agree that it is a limitation that data on episiotomy was not validated. &nbsp;  We have edited our Discussion to acknowledge this limitation and referenced the Stedenfeldt et al study as follows: \u201cWhile episiotomy was defined according to standard practice at CUMH (i.e., right mediolateral incision), this data could not be validated as we were reliant on secondary data only for the current study. Episiotomies angled at 40\u201360&deg; are associated with a reduced risk of third and fourth degree tears compared to episiotomies with a more acute angle (1). Therefore, a validated measure of episiotomy is necessary to maximise model performance.\u201d  2. \n<i>Further, there is no mention if manual support technique was used or not. This affects greatly for the risk factors as well for OASIS rate. Please, read the article from Hals et a. A Multicenter Interventional Program to Reduce the Incidence of Anal Sphincter Tears Obstet Gynecol 2010;116:901\u20138 for future research. And finally, which kind of support technique was used.<\/i>  &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Thank you for bringing the Hals et al study to our attention. Standard practice at CUMH is to use manual support technique for vaginal deliveries. We have incorporated this into our manuscript as follows and referenced the Hals et al study:  Mode of delivery (with manual support technique (2)) was categorised into four different groups as follows: spontaneous vaginal delivery with episiotomy, spontaneous vaginal delivery without episiotomy, forceps delivery and ventouse delivery.\u201d  We hope these amendments address the suggestions raised. Should any further amendments be necessary, we would be happy to address them accordingly.&nbsp;  Sincerely,  Dr Gillian Maher, Dr Laura O\u2019Byrne, Dr Joye McKernan, Dr Paul Corcoran, Prof Richard&nbsp; Greene, Dr Ali Khashan and Dr Fergus McCarthy  \n<b>References<\/b> 1.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Stedenfeldt M, Pirhonen J, Blix E, Wilsgaard T, Vonen B, &Oslash;ian P. Episiotomy characteristics and risks for obstetric anal sphincter injuries: a case-control study. BJOG : an international journal of obstetrics and gynaecology. 2012;119(6):724-30. 2.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Hals E, &Oslash;ian P, Pirhonen T, Gissler M, Hjelle S, Nilsen EB, et al. A Multicenter Interventional Program to Reduce the Incidence of Anal Sphincter Tears. Obstetrics &amp; Gynecology. 2010;116(4):901-8.","URL":"https:\/\/hrbopenresearch.org\/articles\/5-79\/v2#referee-comment-3549","order":1,"name":"referee-comment-3549","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.21956\/hrbopenres.15117.r36502, Emilia Rotstein, Department of Clinical Science, Intervention and Technology - CLINTEC, Karolinska Institutet, Stockholm, 03 Nov 2023, version 2, indexed","URL":"https:\/\/hrbopenresearch.org\/articles\/5-79\/v2#referee-response-36502","order":2,"name":"referee-response-36502","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"Health Research Board [SDAP-2019-017] assigned to Dr Fergus McCarthy. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.","order":3,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}