{"id":"https://openalex.org/W7204173702","doi":"https://doi.org/10.3390/healthcare14172714","title":"Transfer of Restrictive Episiotomy Practice with Low OASIS Rate from Tertiary to Primary Care Level\u2014Lessons Learned and Future Challenges","display_name":"Transfer of Restrictive Episiotomy Practice with Low OASIS Rate from Tertiary to Primary Care Level\u2014Lessons Learned and Future Challenges","publication_year":2026,"publication_date":"2026-08-25","ids":{"openalex":"https://openalex.org/W7204173702","doi":"https://doi.org/10.3390/healthcare14172714","pmid":"https://pubmed.ncbi.nlm.nih.gov/42736872"},"language":"en","primary_location":{"id":"doi:10.3390/healthcare14172714","doi":"https://doi.org/10.3390/healthcare14172714","is_oa":true,"landing_page_url":"https://doi.org/10.3390/healthcare14172714","pdf_url":null,"source":{"id":"https://openalex.org/S4210214101","display_name":"Healthcare","issn_l":"2227-9032","issn":["2227-9032"],"is_oa":true,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core"],"host_organization":"https://openalex.org/P4310310987","host_organization_name":"Multidisciplinary Digital Publishing Institute","host_organization_lineage":["https://openalex.org/P4310310987"],"host_organization_lineage_names":["Multidisciplinary Digital Publishing Institute"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Healthcare","raw_type":"journal-article"},"volume":null,"type":"article","indexed_in":["crossref","pubmed"],"open_access":{"is_oa":true,"oa_status":"gold","oa_url":"https://doi.org/10.3390/healthcare14172714","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5050861382","display_name":"Ingrid M\u00e1rton","orcid":"https://orcid.org/0000-0002-6529-4412","observed_orcids":["https://orcid.org/0000-0002-6529-4412"]},"institutions":[{"id":"https://openalex.org/I4210086219","display_name":"Klini\u010dka bolnica \"Sveti Duh\"","ror":"https://ror.org/00t8kk495","country_code":"HR","type":"healthcare","lineage":["https://openalex.org/I4210086219"]},{"id":"https://openalex.org/I4210110782","display_name":"Catholic University of Croatia","ror":"https://ror.org/022991v89","country_code":"HR","type":"education","lineage":["https://openalex.org/I4210110782"]}],"countries":["HR"],"is_corresponding":false,"raw_author_name":"Ingrid Marton","raw_affiliation_strings":["School of Medicine, Faculty of Health Studies, Catholic University of Croatia, Ilica 244, 10 000 Zagreb, Croatia","University Department of Gynecology and Obstetrics, Clinical Hospital \u201cSveti Duh\u201d, Sveti Duh 64, 10 000 Zagreb, Croatia"],"raw_orcid":"https://orcid.org/0000-0002-6529-4412","affiliations":[{"raw_affiliation_string":"School of Medicine, Faculty of Health Studies, Catholic University of Croatia, Ilica 244, 10 000 Zagreb, Croatia","institution_ids":["https://openalex.org/I4210110782"]},{"raw_affiliation_string":"University Department of Gynecology and Obstetrics, Clinical Hospital \u201cSveti Duh\u201d, Sveti Duh 64, 10 000 Zagreb, Croatia","institution_ids":["https://openalex.org/I4210086219"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5082642472","display_name":"Matija Prka","orcid":"https://orcid.org/0000-0002-7226-0229","observed_orcids":["https://orcid.org/0000-0002-7226-0229"]},"institutions":[{"id":"https://openalex.org/I4210086219","display_name":"Klini\u010dka bolnica \"Sveti Duh\"","ror":"https://ror.org/00t8kk495","country_code":"HR","type":"healthcare","lineage":["https://openalex.org/I4210086219"]},{"id":"https://openalex.org/I4210110782","display_name":"Catholic University of Croatia","ror":"https://ror.org/022991v89","country_code":"HR","type":"education","lineage":["https://openalex.org/I4210110782"]}],"countries":["HR"],"is_corresponding":false,"raw_author_name":"Matija Prka","raw_affiliation_strings":["School of Medicine, Faculty of Health Studies, Catholic University of Croatia, Ilica 244, 10 000 Zagreb, Croatia","University Department of Gynecology and Obstetrics, Clinical Hospital \u201cSveti Duh\u201d, Sveti Duh 64, 10 000 Zagreb, Croatia"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"School of Medicine, Faculty of Health Studies, Catholic University of Croatia, Ilica 244, 10 000 Zagreb, Croatia","institution_ids":["https://openalex.org/I4210110782"]},{"raw_affiliation_string":"University Department of Gynecology and Obstetrics, Clinical Hospital \u201cSveti Duh\u201d, Sveti Duh 64, 10 000 Zagreb, Croatia","institution_ids":["https://openalex.org/I4210086219"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5065297466","display_name":"Ana Tikvica Lueti\u0107","orcid":"https://orcid.org/0000-0002-2074-8548","observed_orcids":["https://orcid.org/0000-0002-2074-8548"]},"institutions":[{"id":"https://openalex.org/I4210086219","display_name":"Klini\u010dka bolnica \"Sveti Duh\"","ror":"https://ror.org/00t8kk495","country_code":"HR","type":"healthcare","lineage":["https://openalex.org/I4210086219"]},{"id":"https://openalex.org/I4210110782","display_name":"Catholic University of Croatia","ror":"https://ror.org/022991v89","country_code":"HR","type":"education","lineage":["https://openalex.org/I4210110782"]}],"countries":["HR"],"is_corresponding":false,"raw_author_name":"Ana Tikvica Lueti\u0107","raw_affiliation_strings":["School of Medicine, Faculty of Health Studies, Catholic University of Croatia, Ilica 244, 10 000 Zagreb, Croatia","University Department of Gynecology and Obstetrics, Clinical Hospital \u201cSveti Duh\u201d, Sveti Duh 64, 10 000 Zagreb, Croatia"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"School of Medicine, Faculty of Health Studies, Catholic University of Croatia, Ilica 244, 10 000 Zagreb, Croatia","institution_ids":["https://openalex.org/I4210110782"]},{"raw_affiliation_string":"University Department of Gynecology and Obstetrics, Clinical Hospital \u201cSveti Duh\u201d, Sveti Duh 64, 10 000 Zagreb, Croatia","institution_ids":["https://openalex.org/I4210086219"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5086619134","display_name":"Domagoj Dokozi\u0107","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I4405262539","display_name":"Op\u0107a \u017eupanijska bolnica Po\u017eega","ror":"https://ror.org/03x53pw92","country_code":"HR","type":"healthcare","lineage":["https://openalex.org/I4405262539"]}],"countries":["HR"],"is_corresponding":false,"raw_author_name":"Domagoj Dokozi\u0107","raw_affiliation_strings":["Department of Gynecology and Obstetrics, Po\u017eega General County Hospital, Osje\u010dka 107, 34 000 Po\u017eega, Croatia"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Gynecology and Obstetrics, Po\u017eega General County Hospital, Osje\u010dka 107, 34 000 Po\u017eega, Croatia","institution_ids":["https://openalex.org/I4405262539"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5014822641","display_name":"Dubravko Habek","orcid":"https://orcid.org/0000-0002-7675-7064","observed_orcids":["https://orcid.org/0000-0002-7675-7064"]},"institutions":[{"id":"https://openalex.org/I4210110782","display_name":"Catholic University of Croatia","ror":"https://ror.org/022991v89","country_code":"HR","type":"education","lineage":["https://openalex.org/I4210110782"]},{"id":"https://openalex.org/I4210112868","display_name":"Klini\u010dka bolnica Merkur","ror":"https://ror.org/01b6d9h22","country_code":"HR","type":"healthcare","lineage":["https://openalex.org/I4210112868"]}],"countries":["HR"],"is_corresponding":false,"raw_author_name":"Dubravko Habek","raw_affiliation_strings":["School of Medicine, Faculty of Health Studies, Catholic University of Croatia, Ilica 244, 10 000 Zagreb, Croatia","University Department of Gynecology and Obstetrics, Clinical Hospital \u201cMerkur\u201d, Zaj\u010deva 19, 10 000 Zagreb, Croatia"],"raw_orcid":"https://orcid.org/0000-0002-7675-7064","affiliations":[{"raw_affiliation_string":"School of Medicine, Faculty of Health Studies, Catholic University of Croatia, Ilica 244, 10 000 Zagreb, Croatia","institution_ids":["https://openalex.org/I4210110782"]},{"raw_affiliation_string":"University Department of Gynecology and Obstetrics, Clinical Hospital \u201cMerkur\u201d, Zaj\u010deva 19, 10 000 Zagreb, Croatia","institution_ids":["https://openalex.org/I4210112868"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5148103418","display_name":"Sanja Rogina Curman","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I4210086219","display_name":"Klini\u010dka bolnica \"Sveti Duh\"","ror":"https://ror.org/00t8kk495","country_code":"HR","type":"healthcare","lineage":["https://openalex.org/I4210086219"]},{"id":"https://openalex.org/I4210110782","display_name":"Catholic University of Croatia","ror":"https://ror.org/022991v89","country_code":"HR","type":"education","lineage":["https://openalex.org/I4210110782"]}],"countries":["HR"],"is_corresponding":false,"raw_author_name":"Sanja Rogina Curman","raw_affiliation_strings":["School of Medicine, Faculty of Health Studies, Catholic University of Croatia, Ilica 244, 10 000 Zagreb, Croatia","University Department of Gynecology and Obstetrics, Clinical Hospital \u201cSveti Duh\u201d, Sveti Duh 64, 10 000 Zagreb, Croatia"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"School of Medicine, Faculty of Health Studies, Catholic University of Croatia, Ilica 244, 10 000 Zagreb, Croatia","institution_ids":["https://openalex.org/I4210110782"]},{"raw_affiliation_string":"University Department of Gynecology and Obstetrics, Clinical Hospital \u201cSveti Duh\u201d, Sveti Duh 64, 10 000 Zagreb, Croatia","institution_ids":["https://openalex.org/I4210086219"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5075879947","display_name":"Zlatko Hrgovi\u0107","orcid":"https://orcid.org/0000-0001-5504-9256","observed_orcids":["https://orcid.org/0000-0001-5504-9256"]},"institutions":[{"id":"https://openalex.org/I114090438","display_name":"Goethe University Frankfurt","ror":"https://ror.org/04cvxnb49","country_code":"DE","type":"education","lineage":["https://openalex.org/I114090438"]}],"countries":["DE"],"is_corresponding":true,"raw_author_name":"Zlatko Hrgovi\u0107","raw_affiliation_strings":["School of Medicine, Johann Wolfgang Goethe University, 60629 Frankfurt am Main, Germany"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"School of Medicine, Johann Wolfgang Goethe University, 60629 Frankfurt am Main, Germany","institution_ids":["https://openalex.org/I114090438"]}]}],"institutions":[],"countries_distinct_count":2,"institutions_distinct_count":5,"corresponding_author_ids":["https://openalex.org/A5075879947"],"corresponding_institution_ids":["https://openalex.org/I114090438"],"apc_list":{"value":2700,"currency":"CHF","value_usd":3258},"apc_paid":{"value":2700,"currency":"CHF","value_usd":3258},"fwci":0.0,"has_fulltext":true,"cited_by_count":0,"citation_normalized_percentile":{"value":0.6968605,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":"14","issue":"17","first_page":"2714","last_page":"2714"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10453","display_name":"Maternal and Perinatal Health Interventions","score":0.5019999742507935,"subfield":{"id":"https://openalex.org/subfields/2729","display_name":"Obstetrics and Gynecology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T10453","display_name":"Maternal and Perinatal Health Interventions","score":0.5019999742507935,"subfield":{"id":"https://openalex.org/subfields/2729","display_name":"Obstetrics and Gynecology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10418","display_name":"Pelvic floor disorders treatments","score":0.48240000009536743,"subfield":{"id":"https://openalex.org/subfields/2745","display_name":"Rheumatology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T11389","display_name":"Maternal and fetal healthcare","score":0.002300000051036477,"subfield":{"id":"https://openalex.org/subfields/2735","display_name":"Pediatrics, Perinatology and Child Health"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/restrictive-episiotomy","display_name":"restrictive episiotomy","score":0.9800000190734863},{"id":"https://openalex.org/keywords/obstetric-anal-sphincter-injury","display_name":"obstetric anal sphincter injury","score":0.9549999833106995},{"id":"https://openalex.org/keywords/episiotomy-rate","display_name":"episiotomy rate","score":0.8600000143051147},{"id":"https://openalex.org/keywords/lateral-episiotomy","display_name":"lateral episiotomy","score":0.8510000109672546},{"id":"https://openalex.org/keywords/mediolateral-episiotomy","display_name":"mediolateral episiotomy","score":0.9819999933242798},{"id":"https://openalex.org/keywords/obstetric-perineal-trauma","display_name":"obstetric perineal trauma","score":0.9259999990463257},{"id":"https://openalex.org/keywords/primary-care-obstetrics","display_name":"primary care obstetrics","score":0.6389999985694885},{"id":"https://openalex.org/keywords/tertiary-care-obstetrics","display_name":"tertiary care obstetrics","score":0.9459999799728394},{"id":"https://openalex.org/keywords/perineal-trauma-prevention","display_name":"perineal trauma prevention","score":0.5339999794960022},{"id":"https://openalex.org/keywords/transfer-of-practice","display_name":"practice transfer","score":0.42800000309944153},{"id":"https://openalex.org/keywords/zagreb","display_name":"Zagreb","score":0.47999998927116394},{"id":"https://openalex.org/keywords/croatia","display_name":"Croatia","score":0.5120000243186951},{"id":"https://openalex.org/keywords/obstetric-quality-improvement","display_name":"obstetric quality improvement","score":0.3230000138282776}],"concepts":[{"id":"https://openalex.org/C2777362633","wikidata":"https://www.wikidata.org/wiki/Q1137446","display_name":"Episiotomy","level":3,"score":0.9799000024795532},{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.8598999977111816},{"id":"https://openalex.org/C27415008","wikidata":"https://www.wikidata.org/wiki/Q7256382","display_name":"Psychological intervention","level":2,"score":0.5180000066757202},{"id":"https://openalex.org/C2984752397","wikidata":"https://www.wikidata.org/wiki/Q3259956","display_name":"Primary care","level":2,"score":0.4961000084877014},{"id":"https://openalex.org/C131872663","wikidata":"https://www.wikidata.org/wiki/Q5284418","display_name":"Obstetrics","level":1,"score":0.4948999881744385},{"id":"https://openalex.org/C2993285706","wikidata":"https://www.wikidata.org/wiki/Q4751007","display_name":"Anal sphincter","level":2,"score":0.4823000133037567},{"id":"https://openalex.org/C2991842025","wikidata":"https://www.wikidata.org/wiki/Q31207","display_name":"Tertiary care","level":2,"score":0.47620001435279846},{"id":"https://openalex.org/C2779974597","wikidata":"https://www.wikidata.org/wiki/Q28448986","display_name":"Clinical Practice","level":2,"score":0.40310001373291016},{"id":"https://openalex.org/C2776200494","wikidata":"https://www.wikidata.org/wiki/Q7075540","display_name":"Obstetric labor complication","level":3,"score":0.3736000061035156},{"id":"https://openalex.org/C194828623","wikidata":"https://www.wikidata.org/wiki/Q2861470","display_name":"Emergency medicine","level":1,"score":0.373199999332428},{"id":"https://openalex.org/C2992232542","wikidata":"https://www.wikidata.org/wiki/Q20862341","display_name":"Maternity care","level":3,"score":0.3458000123500824},{"id":"https://openalex.org/C3018023364","wikidata":"https://www.wikidata.org/wiki/Q425265","display_name":"Significant difference","level":2,"score":0.33880001306533813},{"id":"https://openalex.org/C2779234561","wikidata":"https://www.wikidata.org/wiki/Q11995","display_name":"Pregnancy","level":2,"score":0.31949999928474426},{"id":"https://openalex.org/C2779703513","wikidata":"https://www.wikidata.org/wiki/Q34581","display_name":"Childbirth","level":3,"score":0.3190000057220459},{"id":"https://openalex.org/C2779473830","wikidata":"https://www.wikidata.org/wiki/Q1540899","display_name":"MEDLINE","level":2,"score":0.31859999895095825},{"id":"https://openalex.org/C63363279","wikidata":"https://www.wikidata.org/wiki/Q5133848","display_name":"Clinical significance","level":2,"score":0.29440000653266907},{"id":"https://openalex.org/C2993624421","wikidata":"https://www.wikidata.org/wiki/Q16917","display_name":"Hospital care","level":3,"score":0.2694999873638153},{"id":"https://openalex.org/C163432668","wikidata":"https://www.wikidata.org/wiki/Q623543","display_name":"Primary health care","level":3,"score":0.25119999051094055},{"id":"https://openalex.org/C2778408130","wikidata":"https://www.wikidata.org/wiki/Q6679974","display_name":"Vaginal delivery","level":3,"score":0.2506999969482422}],"mesh":[],"locations_count":3,"locations":[{"id":"doi:10.3390/healthcare14172714","doi":"https://doi.org/10.3390/healthcare14172714","is_oa":true,"landing_page_url":"https://doi.org/10.3390/healthcare14172714","pdf_url":null,"source":{"id":"https://openalex.org/S4210214101","display_name":"Healthcare","issn_l":"2227-9032","issn":["2227-9032"],"is_oa":true,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core"],"host_organization":"https://openalex.org/P4310310987","host_organization_name":"Multidisciplinary Digital Publishing Institute","host_organization_lineage":["https://openalex.org/P4310310987"],"host_organization_lineage_names":["Multidisciplinary Digital Publishing Institute"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Healthcare","raw_type":"journal-article"},{"id":"pmid:42736872","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/42736872","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Healthcare (Basel, Switzerland)","raw_type":"Journal Article"},{"id":"pmh:oai:pubmedcentral.nih.gov:13565105","doi":null,"is_oa":true,"landing_page_url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13565105/","pdf_url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13565105/pdf/healthcare-14-02714.pdf","source":{"id":"https://openalex.org/S2764455111","display_name":"PubMed Central","issn_l":null,"issn":null,"is_oa":true,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"Healthcare (Basel)","raw_type":"Text"}],"best_oa_location":{"id":"doi:10.3390/healthcare14172714","doi":"https://doi.org/10.3390/healthcare14172714","is_oa":true,"landing_page_url":"https://doi.org/10.3390/healthcare14172714","pdf_url":null,"source":{"id":"https://openalex.org/S4210214101","display_name":"Healthcare","issn_l":"2227-9032","issn":["2227-9032"],"is_oa":true,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core"],"host_organization":"https://openalex.org/P4310310987","host_organization_name":"Multidisciplinary Digital Publishing Institute","host_organization_lineage":["https://openalex.org/P4310310987"],"host_organization_lineage_names":["Multidisciplinary Digital Publishing Institute"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Healthcare","raw_type":"journal-article"},"sustainable_development_goals":[{"display_name":"Good health and well-being","id":"https://metadata.un.org/sdg/3","score":1.0}],"sustainable_development_goals_aurora":[],"study_designs":[{"display_name":"Observational Study","id":"https://openalex.org/study-designs/observational-study"}],"awards":[],"funders":[],"has_content":{"pdf":false,"grobid_xml":false},"content_urls":null,"referenced_works_count":17,"referenced_works":["https://openalex.org/W1859228893","https://openalex.org/W1967583979","https://openalex.org/W2008647410","https://openalex.org/W2039522777","https://openalex.org/W2067917043","https://openalex.org/W2088296343","https://openalex.org/W2152588758","https://openalex.org/W2313828535","https://openalex.org/W2534355119","https://openalex.org/W2991840050","https://openalex.org/W4200004011","https://openalex.org/W4233188771","https://openalex.org/W4318928091","https://openalex.org/W4385767058","https://openalex.org/W4404473937","https://openalex.org/W4411197004","https://openalex.org/W7166473345"],"related_works":[],"abstract_inverted_index":{"Introduction:":[0],"For":[1],"more":[2,434],"than":[3,440],"40":[4],"years,":[5],"obstetricians":[6],"and":[7,18,49,57,70,95,118,143,179,283,343,351,354,362,374,396,414,423],"midwives":[8],"worldwide":[9],"have":[10],"continued":[11],"to":[12,261,291,302,321,379,436],"debate":[13],"the":[14,22,52,112,115,156,162,166,198,208,223,237,242,248,298,331,341,344,346,355,358,370,377,380,400,409],"significance":[15],"of":[16,20,24,34,51,55,109,114,126,277,289,334,348,357,365,372,386,411],"episiotomy":[17,56,87,98,133,157,275,303,318,395],"methods":[19],"reducing":[21],"rate":[23,158,210,250,276,288],"obstetric":[25,40],"anal":[26],"sphincter":[27],"injuries":[28],"(OASIS).":[29],"Methods:":[30],"A":[31,151],"concise":[32],"review":[33],"relevant":[35],"recently":[36],"published":[37],"articles":[38],"on":[39,100],"perineal":[41,120],"trauma":[42],"was":[43,134,159,184,220,234],"conducted,":[44],"together":[45],"with":[46,214],"an":[47,123,180,272,349],"analysis":[48],"comparison":[50],"annual":[53],"rates":[54,233,398],"OASIS":[58,209,232,249,287,397],"(primary":[59,76],"outcomes)":[60],"at":[61,136,144,222,253,304,311,399],"Clinical":[62,137,305],"Hospital":[63,138,148,306],"\u201cSveti":[64,139,307],"Duh\u201d,":[65],"Zagreb":[66],"(tertiary":[67,170,188],"care":[68,77,171,176,189,194,200,225,382],"level),":[69,78],"Po\u017eega":[71,75,145,312],"General":[72,146,313],"County":[73,147,314],"Hospital,":[74],"over":[79],"a":[80,204,217,263,284],"ten-year":[81],"period":[82,168],"(2015\u20132024).":[83],"Results:":[84],"Routine":[85],"(liberal)":[86],"has":[88,104],"been":[89],"abandoned":[90],"in":[91,141,149,155,207,231,360,391,393,426,438,441],"clinical":[92,428,443],"practice":[93],"worldwide,":[94],"restrictive":[96,300],"(selective)":[97],"based":[99],"strict":[101],"medical":[102,322],"indications":[103],"gained":[105],"widespread":[106],"acceptance.":[107],"Lateralization":[108],"episiotomy,":[110],"slowing":[111],"expulsion":[113],"fetal":[116],"head,":[117],"manual":[119],"protection":[121],"represent":[122],"important":[124,296],"set":[125],"preventive":[127],"interventions":[128],"for":[129,297,420],"avoiding":[130],"OASIS.":[131],"Restrictive":[132],"implemented":[135],"Duh\u201d":[140,308],"2010":[142],"2012.":[150],"statistically":[152,228],"significant":[153,229],"difference":[154,183,230],"observed":[160,185,221],"between":[161,236,241,271],"two":[163,238,243,401],"hospitals":[164,239],"during":[165,186,211,330],"study":[167,244],"2015\u20132019":[169],"level,":[172,177,190,195,201],"22.0%":[173],"vs.":[174,192],"primary":[175,193,224,381],"17.5%),":[178],"even":[181],"greater":[182],"2020\u20132024":[187,212],"31.0%":[191],"17.0%).":[196],"At":[197],"tertiary":[199,378],"we":[202],"detected":[203,235],"slight":[205,218],"increase":[206],"compared":[213],"2015\u20132019,":[215],"whereas":[216],"decrease":[219],"level.":[226,383],"No":[227],"or":[240,268],"periods,":[245],"indicating":[246],"that":[247,408],"remained":[251],"stable":[252],"below":[254],"1%.":[255,292],"Discussion:":[256],"Nowadays,":[257],"it":[258],"is":[259,431],"necessary":[260],"find":[262],"balance":[264],"(when":[265],"using":[266],"mediolateral":[267],"lateral":[269],"episiotomy)":[270],"optimal":[273],"overall":[274,286],"<30%":[278],"(primiparas:":[279],"<50%;":[280],"multiparas:":[281],"<10%)":[282],"corresponding":[285],"up":[290],"Several":[293],"measures":[294,389],"were":[295],"successful":[299],"approach":[301],"and,":[309],"subsequently,":[310],"Hospital:":[315],"(1)":[316],"performing":[317],"strictly":[319],"according":[320],"indications;":[323],"(2)":[324],"individualized":[325],"patient":[326],"assessment;":[327],"(3)":[328],"patience":[329],"second":[332],"stage":[333],"labor;":[335,361],"(4)":[336],"critical":[337],"judgment":[338],"by":[339],"both":[340,394],"obstetrician":[342],"midwife,":[345,353],"availability":[347],"experienced":[350],"skilled":[352],"cooperation":[356],"woman":[359],"(5)":[363],"education":[364],"all":[366,387],"birth":[367],"attendants,":[368],"including":[369],"transfer":[371],"knowledge":[373],"training":[375,413],"from":[376],"The":[384],"implementation":[385],"these":[388],"resulted":[390],"reductions":[392],"hospitals.":[402],"However,":[403],"our":[404],"results":[405],"clearly":[406],"show":[407],"discontinuation":[410],"staff":[412,421],"organizational":[415],"problems":[416],"can":[417],"be":[418],"discouraging":[419],"members":[422],"may":[424],"result":[425],"inappropriate":[427],"practice,":[429],"which":[430],"not":[432],"necessarily":[433],"likely":[435],"occur":[437],"small":[439],"large":[442],"settings.":[444]},"counts_by_year":[],"updated_date":"2026-10-01T08:54:57.152042","created_date":"2026-08-26T00:00:00"}