枕后位胎儿头部位置会增加真空辅助分娩时肛门括约肌损伤的风险。
Occiput posterior fetal head position increases the risk of anal sphincter injury in vacuum-assisted deliveries.
作者信息
Wu Jennifer M, Williams Kathryn S, Hundley Andrew F, Connolly AnnaMarie, Visco Anthony G
机构信息
Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
出版信息
Am J Obstet Gynecol. 2005 Aug;193(2):525-8; discussion 528-9. doi: 10.1016/j.ajog.2005.03.059.
OBJECTIVE
The purpose of this study was to determine whether an occiput posterior (OP) fetal head position increases the risk for anal sphincter injury when compared with an occiput anterior (OA) position in vacuum-assisted deliveries.
STUDY DESIGN
We conducted a retrospective cohort study of 393 vacuum-assisted singleton vaginal deliveries. Maternal demographics and obstetric and neonatal data were collected from an obstetric database and chart review.
RESULTS
Within the OP group, 41.7% developed a third- or fourth-degree laceration compared with 22.0% in the OA group (OR 2.5, 95% CI 1.4-4.7). In a logistic regression model that controlled for BMI, race, nulliparity, length of second stage, episiotomy, birth weight, head circumference, and fetal head position, OP position was 4.0 times (95% CI 1.7-9.6) more likely to be associated with an anal sphincter injury than OA position.
CONCLUSION
Among vacuum deliveries, an OP head position confers an incrementally increased risk for anal sphincter injury over an OA position.
目的
本研究旨在确定在真空辅助分娩中，与枕前位（OA）相比，枕后位（OP）胎儿头部位置是否会增加肛门括约肌损伤的风险。
研究设计
我们对393例真空辅助单胎阴道分娩进行了一项回顾性队列研究。从产科数据库和病历审查中收集产妇人口统计学资料以及产科和新生儿数据。
结果
在枕后位组中，41.7%发生了三度或四度裂伤，而枕前位组为22.0%（比值比2.5，95%置信区间1.4 - 4.7）。在一个控制了体重指数、种族、初产情况、第二产程时长、会阴切开术、出生体重、头围和胎儿头部位置的逻辑回归模型中，枕后位与肛门括约肌损伤相关的可能性是枕前位的4.0倍（95%置信区间1.7 - 9.6）。
结论
在真空分娩中，枕后位胎儿头部位置相比枕前位会使肛门括约肌损伤的风险逐渐增加。
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