{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:56:37Z","timestamp":1787028997610,"version":"build-2736575974"},"reference-count":32,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T00:00:00Z","timestamp":1765324800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Microorganisms"],"abstract":"<jats:p>Perineal tears are common during vaginal delivery and are associated with significant maternal morbidity. While chorioamnionitis and intrapartum fever are known to affect labor dynamics and perineal tissue integrity, their relationship with perineal trauma in spontaneous vaginal deliveries has not been established. This study aimed to evaluate the prevalence of perineal tears among women with intrapartum fever who delivered spontaneously. This retrospective cohort study included women who underwent spontaneous vaginal delivery during 2013\u20132021 in Israel. The study group comprised women diagnosed with intrapartum fever (\u226538 \u00b0C), while afebrile women served as controls in a 1:2 ratio matched by age (&lt;35 or \u226535 years) and gestational age (preterm\/term). Perineal tears were classified according to the Royal College of Obstetricians and Gynaecologists (RCOG) criteria. Multivariable logistic regression was performed to adjust for statistically significant variables including obesity, induction of labor, epidural analgesia, amniotomy, delivery week, gestational diabetes, birth number, duration of the second stage of labor, and episiotomy. The cohort included 373 women with intrapartum fever and 746 controls. The overall rate of perineal tears was similar between febrile and afebrile women (42% vs. 40%; adjusted odds ratio [aOR] 0.99, 95% confidence interval [CI] 0.72\u20131.36). However, the rate of obstetric anal sphincter injury (OASIS) was lower among women with intrapartum fever (0.5% vs. 2.0%; aOR 0.10, 95% CI 0.02\u20130.52). Intrapartum fever was associated with higher rates of postpartum hemorrhage, manual exploration of the uterus, endometritis, anemia, and blood transfusion. Bacterial cultures were positive in 31% of febrile women, predominantly Escherichia coli and Group B Streptococcus, without association with perineal trauma. Alltogether, Intrapartum fever did not increase the risk of perineal tears in spontaneous vaginal deliveries and was paradoxically associated with a lower rate of OASIS. Further studies are warranted to explore the underlying physiological mechanisms linking temperature and perineal tissue resilience.<\/jats:p>","DOI":"10.3390\/microorganisms13122815","type":"journal-article","created":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T14:22:40Z","timestamp":1765376560000},"page":"2815","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["The Prevalence of Perineal Tears Among Women Having Spontaneous Vaginal Births with Intrapartum Fever"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5537-7935","authenticated-orcid":false,"given":"Manal","family":"Massalha","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Emek Medical Center, Afula 1834111, Israel"},{"name":"The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5345-6138","authenticated-orcid":false,"given":"Eyal","family":"Rom","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Emek Medical Center, Afula 1834111, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayelet","family":"Gertner Bonfis","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Emek Medical Center, Afula 1834111, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haya","family":"Khalilieh Suleiman","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Emek Medical Center, Afula 1834111, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marwa","family":"Diab","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Emek Medical Center, Afula 1834111, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3102-0739","authenticated-orcid":false,"given":"Enav","family":"Yefet","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Tzafon Medical Center, Poriya 1528001, Israel"},{"name":"Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zohar","family":"Nachum","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Emek Medical Center, Afula 1834111, Israel"},{"name":"The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Smith, L.A., Price, N., Simonite, V., and Burns, E.E. (2013). Incidence of and Risk Factors for Perineal Trauma: A Prospective Observational Study. BMC Pregnancy Childbirth, 13.","DOI":"10.1186\/1471-2393-13-59"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1145","DOI":"10.1111\/1471-0528.12571","article-title":"Contribution of the Second Stage of Labour to Pelvic Floor Dysfunction: A Prospective Cohort Comparison of Nulliparous Women","volume":"121","author":"Rogers","year":"2014","journal-title":"BJOG"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1007\/s00192-015-2795-5","article-title":"Risk Factors for Severe Obstetric Perineal Lacerations","volume":"27","author":"Pereira","year":"2016","journal-title":"Int. Urogynecol J."},{"key":"ref_4","unstructured":"International Consultation on Incontinence and the Royal College of Obstetricians and Gynaecologists (RCOG) (2015, June 01). The Management of Third-and Fourth-Degree Perineal Tears Green-Top Guideline No. 29, Available online: https:\/\/www.rcog.org.uk\/media\/5jeb5hzu\/gtg-29.pdf."},{"key":"ref_5","first-page":"745","article-title":"Obstetric Lacerations: Prevention and Repair","volume":"103","author":"Arnold","year":"2021","journal-title":"Am. Fam. Physician"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"35","DOI":"10.31128\/AFP-09-17-4333","article-title":"Perineal Tears\u2014A Review","volume":"47","author":"Goh","year":"2018","journal-title":"Aust. J. Gen. Pract."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Yamada, A., Takahashi, Y., Usami, Y., and Tamakoshi, K. (2024). Impact of Perineal Pain and Delivery Related Factors on Interference with Activities of Daily Living until 1 Month Postpartum: A Longitudinal Prospective Study. BMC Pregnancy Childbirth, 24.","DOI":"10.1186\/s12884-024-06618-5"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1097\/AOG.0b013e318240df4f","article-title":"Pelvic Floor Disorders After Vaginal Birth: Effect of Episiotomy, Perineal Laceration, and Operative Birth","volume":"119","author":"Handa","year":"2012","journal-title":"Obstet. Gynecol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1016\/j.ijgo.2014.03.025","article-title":"Long-Term Outcome of Obstetric Anal Sphincter Injury Repaired by Experienced Obstetricians","volume":"126","author":"Salim","year":"2014","journal-title":"Int. J. Gynecol. Obstet."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1016\/j.clp.2010.02.003","article-title":"Diagnosis and Management of Clinical Chorioamnionitis","volume":"37","author":"Tita","year":"2010","journal-title":"Clin. Perinatol."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"(2017). Committee Opinion No. 712: Intrapartum Management of Intraamniotic Infection. Obstet. Gynecol., 130, e95\u2013e101.","DOI":"10.1097\/AOG.0000000000002236"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1097\/00003081-197006000-00005","article-title":"CHORIOAMNIONITIS","volume":"13","author":"MacVICAR","year":"1970","journal-title":"Clin. Obstet. Gynecol."},{"key":"ref_13","first-page":"71","article-title":"Diagnosis of Intra-Amniotic Infection","volume":"1","author":"Gibbs","year":"1977","journal-title":"Semin. Perinatol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"816","DOI":"10.1097\/00003081-198612000-00008","article-title":"Diagnosis of Chorioamnionitis","volume":"29","author":"Hollander","year":"1986","journal-title":"Clin. Obstet. Gynecol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/S0889-8545(21)00165-0","article-title":"Acute Chorioamnionitis","volume":"16","author":"Gilstrap","year":"1989","journal-title":"Obs. Gynecol. Clin. N. Am."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1097\/00003081-199312000-00004","article-title":"Chorioamnionitis and Intraamniotic Infection","volume":"36","author":"Newton","year":"1993","journal-title":"Clin. Obs. Gynecol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1016\/j.clp.2005.05.001","article-title":"Preterm Labor, Preterm Premature Rupture of Membranes, and Chorioamnionitis","volume":"32","author":"Newton","year":"2005","journal-title":"Clin. Perinatol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1625","DOI":"10.1038\/s41372-018-0252-2","article-title":"Risk Factors for Poor Perineal Outcome after Operative Vaginal Delivery","volume":"38","author":"Wilkie","year":"2018","journal-title":"J. Perinatol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1088","DOI":"10.1097\/AOG.0000000000000833","article-title":"Wound Complications After Obstetric Anal Sphincter Injuries","volume":"125","author":"Johnson","year":"2015","journal-title":"Obstet. Gynecol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1016\/j.ajog.2012.12.025","article-title":"Factors Associated with Wound Complications in Women with Obstetric Anal Sphincter Injuries (OASIS)","volume":"208","author":"Stock","year":"2013","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1016\/S0002-9378(87)80158-8","article-title":"The Normal Parturient\u2019s Admission Temperature","volume":"157","author":"Acker","year":"1987","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"S1274","DOI":"10.1016\/j.ajog.2022.11.002","article-title":"Maternal Fever in Labor: Etiologies, Consequences, and Clinical Management","volume":"228","author":"Goetzl","year":"2023","journal-title":"Am. J. Obs. Gynecol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1418","DOI":"10.1080\/14767058.2017.1317740","article-title":"Intrapartum Fever and the Risk for Perinatal Complications\u2014The Effect of Fever Duration and Positive Cultures","volume":"31","author":"Ashwal","year":"2018","journal-title":"J. Matern. Fetal Neonatal Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e14242","DOI":"10.7717\/peerj.14242","article-title":"Retrospective Study of Intrapartum Fever in Term Pregnancies and Adverse Obstetric and Neonatal Outcomes","volume":"10","author":"An","year":"2022","journal-title":"PeerJ"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"933","DOI":"10.1016\/j.ajog.2004.05.044","article-title":"How Long Is Too Long: Does a Prolonged Second Stage of Labor in Nulliparous Women Affect Maternal and Neonatal Outcomes?","volume":"191","author":"Cheng","year":"2004","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"R\u00e4is\u00e4nen, S., Vehvil\u00e4inen-Julkunen, K., Gissler, M., and Heinonen, S. (2010). Up to Seven-Fold Inter-Hospital Differences in Obstetric Anal Sphincter Injury Rates- A Birth Register-Based Study in Finland. BMC Res. Notes, 3.","DOI":"10.1186\/1756-0500-3-345"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1007\/s00404-012-2333-3","article-title":"Impact of Liberal Use of Mediolateral Episiotomy on the Incidence of Obstetric Anal Sphincter Tear","volume":"286","author":"Zafran","year":"2012","journal-title":"Arch. Gynecol. Obs."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1364","DOI":"10.1111\/jog.15212","article-title":"An Extremely Prolonged Second Stage of Labor Increases Maternal Complications but Has No Adverse Effect on Neonatal Outcomes","volume":"48","author":"Hagiwara","year":"2022","journal-title":"J. Obs. Gynaecol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/j.ejogrb.2019.06.011","article-title":"Warm Perineal Compresses during the Second Stage of Labor for Reducing Perineal Trauma: A Meta-Analysis","volume":"240","author":"Magoga","year":"2019","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"843","DOI":"10.1007\/s00404-023-07195-2","article-title":"The Effects of Warm Perineal Compress on Perineal Trauma and Postpartum Pain: A Systematic Review with Meta-Analysis and Trial Sequential Analysis","volume":"309","author":"Maghalian","year":"2023","journal-title":"Arch. Gynecol. Obs."},{"key":"ref_31","first-page":"CD006672","article-title":"Perineal Techniques during the Second Stage of Labour for Reducing Perineal Trauma","volume":"6","author":"Aasheim","year":"2017","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Massalha, M., Iskander, R., Chazan, B., Yefet, E., and Nachum, Z. (2025). Is Gestational Diabetes Mellitus Associated with Peripartum Infections?. Microorganisms, 13.","DOI":"10.3390\/microorganisms13092030"}],"container-title":["Microorganisms"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-2607\/13\/12\/2815\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T08:55:05Z","timestamp":1765443305000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-2607\/13\/12\/2815"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,10]]},"references-count":32,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["microorganisms13122815"],"URL":"https:\/\/doi.org\/10.3390\/microorganisms13122815","relation":{},"ISSN":["2076-2607"],"issn-type":[{"value":"2076-2607","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,10]]}}}