SynthesisBMJ open2015
Does the Finnish intervention prevent obstetric anal sphincter injuries? A systematic review of the literature.
Synthesis in BMJ open, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
13 citing papers in PubMed, 1 synthesis or guideline pooled it.
- A systematic review of non-invasive modalities used to identify women with anal incontinence symptoms after childbirth.International urogynecology journal · 2019Pooled it
- Effects of manual perineal protection and pushing techniques used in the second stage of labor on perineal outcomes: a randomized controlled trial of combinations of strategies.BMC pregnancy and childbirth · 2025Trial
- Clinical guidance paper VVOG-CRGOLFB prevention and management of obstetrical perineal trauma.European journal of obstetrics & gynecology and reproductive biology: X · 2025Article
- Birth and Regulation of head Extension to Guide Manual perineal Assistance (BREGMA) study: a prospective cohort study.BMC pregnancy and childbirth · 2025Article
- Prevention of obstetric anal sphincter injuries with perineal support and lateral episiotomy: A historical cohort study.Acta obstetricia et gynecologica Scandinavica · 2024Article
- Modifiable and non-modifiable risk factors for obstetric anal sphincter injury in a Norwegian Region: a case-control study.BMC pregnancy and childbirth · 2022Article
- Perineal Lacerations: A Retrospective Study in a Habitual-Risk Public Maternity.Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia · 2021Article
- Risk factors for perineal and vaginal tears in primiparous women - the prospective POPRACT-cohort study.BMC pregnancy and childbirth · 2020Article
- Article
- Modified Ritgen Maneuver in Perineal Protection - Sixty-Year Experience.Acta clinica Croatica · 2018Observational
- Risk factors for obstetric anal sphincter injuries (OASI) at a tertiary centre in south India.International urogynecology journal · 2018Article
- Risk of obstetric anal sphincter injury increases with maternal age irrespective of parity: a population-based register study.BMC pregnancy and childbirth · 2017Article
- Midwives' Management during the Second Stage of Labor in Relation to Second-Degree Tears-An Experimental Study.Birth (Berkeley, Calif.) · 2017Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesA rise in obstetric anal sphincter injuries (OASIS) has been observed and a preventive approach, originating in Finland, has been introduced in several European hospitals. The aim of this paper was to systematically evaluate the evidence behind the 'Finnish intervention'.
designA systematic review of the literature conducted according to the Preferred Reporting for Systematic Reviews and Meta-analyses (PRISMA) guidelines. OUTCOME MEASURES: The primary outcome was OASIS. Secondary outcomes were (perinatal): Apgar scores, pH and standard base excess in the umbilical cord, and (maternal): episiotomy, intact perineum, first and second-degree perineal lacerations, duration of second stage, birth position and women's perceptions/birth experiences.
methodsMultiple databases (Cochrane, Embase, Pubmed and SveMed) were systematically searched for studies published up to December 2014. Both randomised controlled trials and observational studies were eligible for inclusion. Studies were excluded if a full-text article was not available. Studies were evaluated by use of international reporting guidelines (eg, STROBE).
resultsOverall, 1042 articles were screened and 65 retrieved for full-text evaluation. Seven studies, all observational and with a level of evidence at 2c or lower, were included and consistently reported a significant reduction in OASIS. All evaluated episiotomy and found a significant increase. Three studies evaluated perinatal outcomes and reported conflicting results. No study reported on other perineal outcomes, duration of the second stage, birth positions or women's perceptions.
conclusionsA reduction in OASIS has been contributed to the Finnish intervention in seven observational studies, all with a low level of evidence. Knowledge about the potential perinatal and maternal side effects and women's perceptions of the intervention is extremely limited and the biological mechanisms underlying the Finnish intervention are not well documented. Studies with a high level of evidence are needed to assess the effects of the intervention before implementation in clinical settings can be recommended.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.