{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"Research Square"}],"indexed":{"date-parts":[[2024,3,3]],"date-time":"2024-03-03T12:49:54Z","timestamp":1709470194131},"posted":{"date-parts":[[2022,8,3]]},"group-title":"In Review","reference-count":0,"publisher":"Research Square Platform LLC","license":[{"start":{"date-parts":[[2022,8,3]],"date-time":"2022-08-03T00:00:00Z","timestamp":1659484800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2022,7,26]]},"abstract":"<jats:title>Abstract<\/jats:title>\n        <jats:p><jats:italic>Introduction: <\/jats:italic>Rates of episiotomy and severe perineal tears (SPT) are indicators of the quality of obstetric care. Time-trends in the reported occurrence of episiotomy and SPT can contribute to understand both, changes in care and in the frequency of risk factors. Therefore, the aim of this research was to estimate time trends in the frequency of SPT in Portugal and its relationship with episiotomy.<jats:italic> <\/jats:italic><jats:italic>Methods: <\/jats:italic>Nationwide register-based study by using data on singleton vaginal deliveries from the national inpatient database of all Portuguese public hospitals between 2000 and 2015. Time-trend analysis using joinpoint regression models was performed to identify trends (joinpoints) and compare time changes in the prevalence of SPT and risk factors expressed as annual percentage change (APC) with 95% Confidence Interval (95% CI). Poisson regression models were fitted to know whether time-trends in SPT rates were explained by changes in risk factors and to assess the association between episiotomy and SPT. Adjusted relative risk (RR) and respective 95% CI were obtained.<jats:italic>Results: <\/jats:italic>From 908 999 singleton vaginal deliveries, 20.6% were instrumental deliveries, 76.7% with episiotomy and 0.56% were complicated by SPT. SPT decreased among women with non-instrumental deliveries and no episiotomy from 2009 onwards (1.3% to 0.7%), whereas SPT kept increasing in women with episiotomy for both non-instrumental (0.1% in 2000 to 0.4% in 2015) and instrumental deliveries (0.7% in 2005 to 2.3% in 2015). Episiotomy was associated with a decrease in SPT with adjusted RR varying between 2000 and 2015 from 0.18 (95%CI:0.13-0.25) to 0.59 (95%CI:0.44-0.79) for non-instrumental deliveries and from 0.45 (95%CI:0.25-0.81) to 0.50 (95%CI:0.40-0.72) for instrumental deliveries. <jats:italic>Conclusions: <\/jats:italic>Episiotomy rate could safely further decrease as the main factor driving SPT rates seems to be an increase in awareness and reporting of SPT particularly among women who underwent an episiotomy.<\/jats:p>","DOI":"10.21203\/rs.3.rs-1898802\/v1","type":"posted-content","created":{"date-parts":[[2022,8,3]],"date-time":"2022-08-03T18:32:40Z","timestamp":1659551560000},"source":"Crossref","is-referenced-by-count":0,"title":["Time Trends in Episiotomy and Severe Perineal Tears in Portugal: A Nationwide Register-based Study"],"prefix":"10.21203","author":[{"given":"Cristina","family":"Teixeira","sequence":"first","affiliation":[{"name":"Instituto de Sa\u00fade P\u00fablica da Universidade do Porto (ISPUP)"}]},{"given":"Elsa","family":"Lorthe","sequence":"additional","affiliation":[{"name":"Instituto de Sa\u00fade P\u00fablica da Universidade do Porto (ISPUP)"}]},{"given":"Henrique","family":"Barros","sequence":"additional","affiliation":[{"name":"Faculdade de Medicina da Universidade do Porto"}]}],"member":"8761","container-title":[],"original-title":[],"link":[{"URL":"https:\/\/www.researchsquare.com\/article\/rs-1898802\/v1","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.researchsquare.com\/article\/rs-1898802\/v1.html","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,16]],"date-time":"2023-10-16T18:26:26Z","timestamp":1697480786000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.researchsquare.com\/article\/rs-1898802\/v1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,8,3]]},"references-count":0,"URL":"https:\/\/doi.org\/10.21203\/rs.3.rs-1898802\/v1","relation":{"is-preprint-of":[{"id-type":"doi","id":"10.1186\/s12884-022-05314-6","asserted-by":"subject"}]},"subject":[],"published":{"date-parts":[[2022,8,3]]},"subtype":"preprint"}}