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Although it is considered to have fewer relapses and better prognosis than NMOSD, the clinical course and outcome of MOGAD has not been fully characterized. To evaluate the impact of a care bundle (antenatal information to women, manual perineal protection and mediolateral episiotomy when indicated) on obstetric anal sphincter injury (OASI) rates. Multicentre stepped-wedge cluster design. Sixteen maternity units located in four regions across England, Scotland and Wales. Women with singleton live births between October 2016 and March 2
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