Evidence map›Paper›PMID 40715780›Full record

ReviewInternational journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics2026

Detection of obstetric anal sphincter injuries: From the fear of malpractice to a quality indicator of a center.

Ruwan Fernando, Ewa Barcz, Antonino Spinelli, Renaud de Tayrac, Carlo Ratto, Stavros Athanasiou, Diaa Essameldin Ali Rizk, Andrea Stuart, Jan Baekelandt, Hynek Heřman and 7 more

Abstract readReview
In one paragraph

Review in International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from 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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Detection of obstetric anal sphincter injuries: From the fear of malpractice to a quality indicator of a center.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2026
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

17 authors.

Ruwan FernandoDepartment of Urogynaecology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK.
Ewa BarczDepartment of Gynecology and Obstetrics, Medical Faculty of Cardinal Stefan Wyszyński University, Multidisciplinary Hospital Warsaw Międzylesie, Poland.
Antonino SpinelliDepartment of Biomedical Sciences, Humanitas University, Milan, Italy.
Renaud de TayracDepartment of Obstetrics and Gynaecology, Nimes University Hospital, Nîmes, France.
Carlo RattoProctology and Pelvic Floor Surgery Unit, Isola Tiberina Hospital, Gemelli Isola, Catholic University, Rome, Italy.
Stavros AthanasiouUrogynecology Unit, Alexandra Hospital, Kapodistrian University of Athens, Greece.
Diaa Essameldin Ali RizkClinical Research Center, Arabian Gulf University, Bahrain.
Andrea StuartDepartment of Obstetrics and Gynecology, Helsingborg Central Hospital, Helsingborg, Sweden.
Jan BaekelandtDepartment of Obstetrics and Gynecology, Imelda Hospital, Bonheiden, Belgium.
Hynek Heřman3rd Medical Faculty, Charles University, Prague, Czech Republic.ORCID https://orcid.org/0000-0001-5732-3159
Petr JankuDepartment of Obstetrics and Gynecology, University Hospital Brno and Medical Faculty, Masaryk University, Brno, Czech Republic.
Peter RosenblatDivision of Urogynecology and Reconstructive Pelvic Surgery, Cambridge Department of Obstetrics and Gynecology, Harvard Medical School, Boston, Massachusetts, USA.
Adam DzikiDepartment of General and Colorectal Surgery, Medical University of Łódź, Łódź, Poland.
Mariusz GrzesiakInstitute of Polish Mother's Health Center, Łódź, Poland.
Przemysław OszukowskiDepartment of Perinatology and Gynecology, Polish Mother's Memorial Hospital Research Institute, Łódź, Poland.
Katarzyna BoryckaDepartment of General Surgery, Faculty of Medicine, Lazarski University, Warsaw, Poland.ORCID https://orcid.org/0000-0001-6022-2906
Stefano SalvatoreObstetrics and Gynaecology Unit, Vita-Salute San Raffaele University Milan, Italy IRCCS San Raffaele Scientific Institute, Milan, Italy.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Obstetric anal sphincter injuries (OASIs) constitute a significant complication in vaginal childbirth, affecting up to 26% of deliveries and representing the leading cause of anal incontinence among women. Despite their prevalence and serious long-term consequences, OASIs remain widely underreported, partly because of clinicians' hesitancy linked to fear of litigation, peer criticism, and a pervasive culture that discourages disclosure of adverse events. Recent evidence emphasizes that underreporting exacerbates rather than mitigates legal risks and patient harm, underscoring the urgent need for systemic changes. This article reviews critical factors contributing to OASI underreporting, including inadequate clinical training, inconsistent national guidelines, variable litigation landscapes, and differing diagnostic practices across European healthcare systems. Examples from the UK, Poland, Sweden, Norway, France, Italy, the Czech Republic, and Belgium demonstrate significant variations in prevention strategies, diagnostic accuracy, and management protocols, reflecting uneven progress and highlighting opportunities for standardized care improvements. These national discrepancies in OASI definitions, classification, and reporting thresholds may lead to significant inconsistencies in both clinical outcomes and statistical comparisons across healthcare systems. Implementing structured training, standardized protocols, multidisciplinary collaboration, and transparent reporting systems are essential for improving maternal outcomes and reducing litigation risks. Encouraging an institutional culture of accountability and openness will support continuous improvement, ensuring enhanced patient safety and quality care across global healthcare systems.

Indexed as

Anal CanalDelivery, ObstetricMalpracticeObstetric Labor ComplicationsEuropeFearFecal IncontinenceFemaleHumansPractice Guidelines as TopicPregnancyQuality Indicators, Health Carehealthcare transparencymaternal healthcareOASIobstetric care qualityvaginal delivery

Identifiers

PMID40715780
PMCPMC12790666

What Socratic holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

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 Socratic graph.