Tincello Douglas G, Williams Abimbola, Fowler Gillian E, Adams Elisabeth J, Richmond David H, Alfirevic Zarko
Department of Obstetrics and Gynaecology, University of Leicester, Leicester Royal Infirmary, UK.
BJOG. 2003 Dec;110(12):1041-4.
To examine the practice of making an episiotomy and to determine any differences in practice between professional groups.
A prospective survey.
A large tertiary referral obstetric hospital and the obstetric department of a district general hospital.
All staff routinely involved in the care of women in labour.
A novel validated pictorial questionnaire was designed, validated and distributed to the study population. Differences in outcome measures were compared by profession and by seniority.
Measurements taken from the questionnaire: the length of episiotomy drawn; the distance from the sagittal plane at which the episiotomy was begun; and the angle of the episiotomy from the sagittal plane.
Fifty doctors and 78 midwives completed the forms. Median distance of the episiotomy from the midline was 0 mm (-2 to 11). Episiotomies drawn by doctors were significantly longer and more angled than those drawn by midwives (P = 0.002 and P = 0.001). Sixteen percent of doctors and 1% of midwives drew an episiotomy longer than 20 mm (difference 15%, 95% CI 6 to 24). Twenty-three percent of midwives and 2% of doctors drew an episiotomy angled 30 degrees or less (difference 21%, 95% CI 9 to 34).
This study has demonstrated differences in the reporting of episiotomy practice by doctors and midwives. Theoretically, the differences demonstrated could predispose to a greater risk of anal sphincter injuries. These data need to be confirmed by observational studies of actual practice and by studies to investigate the mechanics of sphincter injury during childbirth.
研究会阴切开术的实施情况，并确定不同专业群体在实施过程中的差异。
前瞻性调查。
一家大型三级转诊产科医院和一家地区综合医院的产科。
所有常规参与分娩妇女护理的工作人员。
设计了一种经过验证的新型图片问卷，进行验证后分发给研究对象。按专业和资历比较结果指标的差异。
从问卷中获取的测量数据：画出的会阴切开术长度；会阴切开术开始处与矢状面的距离；以及会阴切开术与矢状面的夹角。
50名医生和78名助产士完成了问卷。会阴切开术距中线的中位距离为0毫米（-2至11）。医生画出的会阴切开术明显比助产士画出的更长且角度更大（P = 0.002和P = 0.001）。16%的医生和1%的助产士画出的会阴切开术长度超过20毫米（差异15%，95%可信区间6至24）。23%的助产士和2%的医生画出的会阴切开术角度为30度或更小（差异21%，95%可信区间9至34）。
本研究表明医生和助产士在会阴切开术实施情况的报告上存在差异。从理论上讲，所显示的差异可能会增加肛门括约肌损伤的风险。这些数据需要通过对实际操作的观察性研究以及调查分娩期间括约肌损伤机制的研究来证实。
