Röckner G, Fianu-Jonasson A
Department of Obstetrics and Gynaecology, Karolinska Institute, Huddinge University Hospital, Sweden.
Br J Obstet Gynaecol. 1999 Feb;106(2):95-101. doi: 10.1111/j.1471-0528.1999.tb08207.x.
To study changes in the use of episiotomy since 1989, controlling for variables such as severe tears, epidural anaesthesia, duration of the second stage of labour, instrumental deliveries, birthweight and maternal position at delivery.
Retrospective study. Data were obtained from original birth records and questionnaires.
Huddinge University Hospital and all labour wards (n = 62) in Sweden.
10,661 women who were delivered vaginally (4575 nulliparae, 6086 multiparae) between 1992 and 1994, and 3366 nulliparae delivered in all Swedish hospitals during the month of March 1995.
Episiotomy rates, severe tears and instrumental deliveries.
The rate of episiotomy was 1% and of severe tears 0.6% among multiparae delivered vaginally (including instrumental deliveries) at Huddinge University Hospital between 1992 and 1994. The rate of episiotomy was 6.6% and of severe tears 2.3% among nulliparae. Vacuum extraction and epidural anaesthesia were more commonly associated with episiotomy. Factors significantly associated with severe tears were infant birthweight > or = 4000 g, vacuum extraction and episiotomy. In all Swedish labour wards in 1995 the mean incidence of episiotomy in nulliparae was 24.5%, a significant decrease from 33.7% in 1989. Wide variations occurred between hospitals (4%-50%).
The use of episiotomy was much reduced at Huddinge University Hospital, with a consistently low rate of severe tears. This supports the growing evidence for individualised and restrictive use of episiotomy at childbirth.
研究自1989年以来会阴切开术的使用变化情况，同时控制诸如严重撕裂伤、硬膜外麻醉、第二产程时长、器械助产、出生体重及分娩时产妇体位等变量。
回顾性研究。数据源自原始分娩记录及调查问卷。
胡丁厄大学医院及瑞典所有的产房（共62个）。
1992年至1994年间经阴道分娩的10661名女性（4575名单产妇，6086名经产妇），以及1995年3月在瑞典所有医院分娩的3366名单产妇。
会阴切开术发生率、严重撕裂伤及器械助产情况。
1992年至1994年间在胡丁厄大学医院经阴道分娩（包括器械助产）的经产妇中，会阴切开术发生率为1%，严重撕裂伤发生率为0.6%。单产妇中会阴切开术发生率为6.6%，严重撕裂伤发生率为2.3%。真空吸引助产及硬膜外麻醉与会阴切开术的相关性更高。与严重撕裂伤显著相关的因素包括婴儿出生体重≥4000克、真空吸引助产及会阴切开术。1995年在瑞典所有产房，单产妇会阴切开术的平均发生率为24.5%，较1989年的33.7%有显著下降。各医院之间存在很大差异（4% - 50%）。
胡丁厄大学医院会阴切开术的使用大幅减少，严重撕裂伤发生率持续较低。这支持了越来越多关于分娩时个体化及限制性使用会阴切开术的证据。
