Robinson J N, Norwitz E R, Cohen A P, Lieberman E
Harvard Medical School, Department of Maternal Fetal Medicine, Brigham & Women's Hospital, Boston, Massachusetts 02115, USA.
Obstet Gynecol. 2000 Aug;96(2):214-8. doi: 10.1016/s0029-7844(00)00868-1.
To identify factors associated with the use of episiotomy at spontaneous vaginal delivery.
We studied 1576 consecutive term, singleton, spontaneous vaginal deliveries in nulliparas at Brigham & Women's Hospital between December 1, 1994 and July 31, 1995. The association of demographic variables and obstetric factors with the rate of episiotomy use were examined. Adjusted odds ratios (OR) and confidence intervals (CI) were estimated from multiple logistic regression analysis.
The overall rate of episiotomy was 40.6% (640 of 1576). Midwives performed episiotomies at a lower rate (21.4%) than faculty (33.3%) and private providers (55.6%) (P =. 001). After controlling for confounding factors with logistic regression, private practice provider was the strongest predictor of episiotomy use (OR, 4.1; 95% CI, 3.1, 5.4) followed by faculty provider (OR, 1.7; 95% CI, 1.1, 2.5), prolonged second stage of labor (OR, 1.8; 95% CI, 1.2, 2.7), fetal macrosomia (OR, 1.6; 95% CI, 1.1, 2.5), and epidural analgesia (OR 1.4, 95% CI, 1.1, 1.8).
The strongest factor associated with episiotomy at delivery was the category of obstetric provider. Obstetric and demographic factors evaluated did not readily explain this association.
确定自然阴道分娩时会阴切开术使用的相关因素。
我们研究了1994年12月1日至1995年7月31日期间在布莱根妇女医院连续进行的1576例初产妇足月、单胎、自然阴道分娩病例。研究了人口统计学变量和产科因素与会阴切开术使用率之间的关联。通过多元逻辑回归分析估计调整后的优势比（OR）和置信区间（CI）。
会阴切开术的总体使用率为40.6%（1576例中的640例）。助产士进行会阴切开术的比例（21.4%）低于教员（33.3%）和私人执业医生（55.6%）（P = 0.001）。在通过逻辑回归控制混杂因素后，私人执业医生是会阴切开术使用的最强预测因素（OR，4.1；95%CI，3.1，5.4），其次是教员（OR，1.7；95%CI，1.1，2.5）、第二产程延长（OR，1.8；95%CI，1.2，2.7）、胎儿巨大（OR，1.6；95%CI，1.1，2.5）和硬膜外镇痛（OR 1.4，95%CI，1.1，1.8）。
分娩时与会阴切开术相关的最强因素是产科医生的类别。所评估的产科和人口统计学因素并不能轻易解释这种关联。
