{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T16:10:10Z","timestamp":1776355810535,"version":"3.51.2"},"reference-count":26,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2023,3,18]],"date-time":"2023-03-18T00:00:00Z","timestamp":1679097600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>The main objective of this study was to evaluate the association between maternal and fetal anthropometric characteristics and third- and fourth-degree perineal tears. This retrospective cohort study considered all consecutive pregnancies from 2011 to 2017 at a single Institution. The inclusion criteria were: singletons who delivered vaginally during the study period, the presence of information on maternal pre-pregnancy weight, maternal height, and weight of the newborn. The feto-maternal body-mass index (BMI) was calculated as neonatal weight in kg on maternal height in squared meters (kg\/m2). In total, 5397 singleton-term pregnancies were included; the prevalence of third-fourth-degree perineal tears was 0.47%. The most predictive factors were: nulliparity, feto-maternal BMI, neonatal weight, gestational age at delivery, and neonatal head circumference. After adjustment in multivariate analysis, the only independent predictors were nulliparity and fetomaternal BMI. The AUC of the final multivariate model was 73.54% (95% CI 65.65\u201381.42). Furthermore, feto-maternal BMI and gestational age had a significant direct correlation. Nulliparity and feto-maternal BMI are the two best predictors for third and fourth-degree perineal tears in our setting. Confirming this association in future research and integrating it into a decision algorithm on delivery timing could reduce obstetric damage to the anal sphincter.<\/jats:p>","DOI":"10.3390\/jpm13030545","type":"journal-article","created":{"date-parts":[[2023,3,20]],"date-time":"2023-03-20T04:33:31Z","timestamp":1679286811000},"page":"545","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Anthropometric Features and Third-Fourth Degree Perineal Tears"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8958-6049","authenticated-orcid":false,"given":"Arrigo","family":"Fruscalzo","sequence":"first","affiliation":[{"name":"Clinic of Obstetrics and Gynecology, University Hospital of Fribourg, 1752 Fribourg, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alice","family":"Novak","sequence":"additional","affiliation":[{"name":"Clinic of Obstetrics and Gynecology, DAME, Academic Hospital of Udine, 33100 Udine, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Camilla","family":"Somma","sequence":"additional","affiliation":[{"name":"Clinic of Obstetrics and Gynecology, DAME, Academic Hospital of Udine, 33100 Udine, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8887-3823","authenticated-orcid":false,"given":"Anjeza","family":"Xholli","sequence":"additional","affiliation":[{"name":"Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale San Martino, 16132 Genoa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-4327-0755","authenticated-orcid":false,"given":"Virginia","family":"Michelerio","sequence":"additional","affiliation":[{"name":"Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale San Martino, 16132 Genoa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7793-714X","authenticated-orcid":false,"given":"Federico","family":"Prefumo","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology Unit, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6429-1220","authenticated-orcid":false,"given":"Ambrogio","family":"Londero","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology Unit, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy"},{"name":"Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Infant Health, University of Genoa, 16132 Genova, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2714-623X","authenticated-orcid":false,"given":"Angelo","family":"Cagnacci","sequence":"additional","affiliation":[{"name":"Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale San Martino, 16132 Genoa, Italy"},{"name":"Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Infant Health, University of Genoa, 16132 Genova, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,3,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"232-e1","DOI":"10.1016\/j.ajog.2017.11.569","article-title":"Long-term anal incontinence after obstetric anal sphincter injury-does grade of tear matter?","volume":"218","author":"Saske","year":"2018","journal-title":"Am. J. Obs. Gynecol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"849","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":"Jha","year":"2016","journal-title":"Int. Urogynecol. J."},{"key":"ref_3","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":"ref_4","first-page":"1021","article-title":"Risk of repetition of a severe perineal laceration","volume":"93","author":"Peleg","year":"1999","journal-title":"Obs. Gynecol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1621","DOI":"10.1007\/s00192-014-2406-x","article-title":"National survey of perineal trauma and its subsequent management in the United Kingdom","volume":"25","author":"Thiagamoorthy","year":"2014","journal-title":"Int. Urogynecol. J."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Bertozzi, S., Londero, A.P., Fruscalzo, A., Driul, L., Delneri, C., Calcagno, A., Di Benedetto, P., and Marchesoni, D. (2011). Impact of episiotomy on pelvic floor disorders and their influence on women\u2019s wellness after the sixth month postpartum: A retrospective study. BMC. Women\u2019s Health, 11.","DOI":"10.1186\/1472-6874-11-12"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1080\/19317610903408130","article-title":"Prevalence and Risk Factors for Dyspareunia and Unsatisfying Sexual Relationships in a Cohort of Primiparous and Secondiparous Women after 12 Months Postpartum","volume":"22","author":"Bertozzi","year":"2010","journal-title":"Int. J. Sex. Health"},{"key":"ref_8","first-page":"89","article-title":"Prevalence of urinary incontinence and pelviperineal rehabilitation during the postpartum in a cohort of primipara and secondipara patients","volume":"61","author":"Driul","year":"2009","journal-title":"Minerva Ginecol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1016\/j.ejogrb.2020.02.025","article-title":"Risk factors for severe perineal trauma during childbirth: An updated meta-analysis","volume":"247","author":"Pergialiotis","year":"2020","journal-title":"Eur. J. Obs. Gynecol. Reprod. Biol."},{"key":"ref_10","unstructured":"Fernando, R., Sultan, A., Freeman, R., Williams, A., and Adams, E. (2015). Green-Top Guideline No. 29: The Management of Third- and Fourth-Degree Perineal Tears, Royal College of Obstetricians and Gynaecologists."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Jansson, M.H., Franz\u00e9n, K., Hiyoshi, A., Tegerstedt, G., Dahlgren, H., and Nilsson, K. (2020). Risk factors for perineal and vaginal tears in primiparous women\u2014The prospective POPRACT-cohort study. BMC Pregnancy Childbirth, 20.","DOI":"10.1186\/s12884-020-03447-0"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1667","DOI":"10.1007\/s00192-022-05164-y","article-title":"What are the factors that may predict the severity of perineal tears in obstetric anal sphincter injuries and how are their outcomes? A 10-year retrospective analysis in a Southeast Asian population","volume":"33","author":"Tan","year":"2022","journal-title":"Int. Urogynecol. J."},{"key":"ref_13","first-page":"S300","article-title":"Fetomaternal BMI\u2014A novel ultrasound predictor of obstetric anal sphincter injury","volume":"21","author":"Cartwright","year":"2010","journal-title":"Int. Urogynecology J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"100090","DOI":"10.1016\/j.xagr.2022.100090","article-title":"Child-Mother Index: A new risk factor for selected adverse maternal birth outcomes","volume":"2","author":"Khalil","year":"2022","journal-title":"AJOG Glob. Rep."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1111\/j.1479-828X.2009.01003.x","article-title":"Guidelines for the management of hypertensive disorders of pregnancy 2008","volume":"49","author":"Lowe","year":"2009","journal-title":"Aust. N. Z. J. Obs. Gynaecol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e5515","DOI":"10.1097\/MD.0000000000005515","article-title":"A possible new approach in the prediction of late gestational hypertension: The role of the fetal aortic intima-media thickness","volume":"96","author":"Visentin","year":"2017","journal-title":"Medicine"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1016\/j.preghy.2011.01.005","article-title":"Influence of the couple on hypertensive disorders during pregnancy: A retrospective cohort study","volume":"1","author":"Bertozzi","year":"2011","journal-title":"Pregnancy Hypertens."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"445","DOI":"10.3109\/09513591003632092","article-title":"Menstrual abnormalities and predisposition to pregnancy-related hypertensive disorders: A retrospective study","volume":"26","author":"Fruscalzo","year":"2010","journal-title":"Gynecol. Endocrinol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"666","DOI":"10.3109\/09513590.2013.798273","article-title":"High placental index and poor pregnancy outcomes: A retrospective study of 18,386 pregnancies","volume":"29","author":"Londero","year":"2013","journal-title":"Gynecol. Endocrinol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1055\/s-0043-122230","article-title":"Fetal Abdominal Aorta: Doppler and Structural Evaluation of Endothelial Function in Intrauterine Growth Restriction and Controls","volume":"40","author":"Visentin","year":"2019","journal-title":"Ultraschall Med."},{"key":"ref_21","unstructured":"R Core Team (2022). R: A Language and Environment for Statistical Computing, R Foundation for Statistical Computing."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1097\/SPV.0000000000000777","article-title":"A Clinical Risk Model to Predict Obstetric Anal Sphincter Injuries in Laboring Patients","volume":"26","author":"Woo","year":"2020","journal-title":"Female Pelvic Med. Reconstr. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1055\/a-0576-0143","article-title":"Can Sonographic Fetal Biometry Predict Adverse Perinatal Outcome?","volume":"40","author":"Pretscher","year":"2019","journal-title":"Ultraschall Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1007\/s00192-019-04108-3","article-title":"What is the total impact of an obstetric anal sphincter injury? An Australian retrospective study","volume":"31","author":"Evans","year":"2020","journal-title":"Int. Urogynecol. J."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1056\/NEJMoa1800566","article-title":"Labor Induction versus Expectant Management in Low-Risk Nulliparous Women","volume":"379","author":"Grobman","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1016\/j.ajog.2019.02.046","article-title":"Elective induction of labor at 39 weeks compared with expectant management: A meta-analysis of cohort studies","volume":"221","author":"Grobman","year":"2019","journal-title":"Am. J. Obs. Gynecol."}],"container-title":["Journal of Personalized Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4426\/13\/3\/545\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:58:32Z","timestamp":1760122712000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4426\/13\/3\/545"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3,18]]},"references-count":26,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2023,3]]}},"alternative-id":["jpm13030545"],"URL":"https:\/\/doi.org\/10.3390\/jpm13030545","relation":{},"ISSN":["2075-4426"],"issn-type":[{"value":"2075-4426","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3,18]]}}}