Sheiner Eyal, Walfisch Asnat, Hallak Mordechai, Harlev Shlomit, Mazor Moshe, Shoham-Vardi Ilana
Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben Gurion University of the Negev, Beer-Sheva, Israel.
J Reprod Med. 2006 Feb;51(2):115-9.
To evaluate possible risk factors for spontaneous and induced perineal damage during vaginal delivery.
A prospective, observational study was conducted with 300 patients at 37-42 weeks of singleton gestation who presented in active labor. Sociodemographic data, birth circumstances and past medical history were obtained upon admission. Perineal damage was assessed before repair and 24 hours postpartum. A multiple logistic regression model was constructed to investigate independent risk factors for spontaneous perineal lacerations.
Of 300 women included, 139 were primiparas. Episiotomy was performed in 32% of the population (62% in primiparas, 6% in multiparas). Spontaneous perineal tears requiring suturing occurred in 28%. Severe perineal tears (grades 3 and 4) occurred in 1%. Risk factors for adverse perineal outcome in the nonepisiotomy group included younger maternal age, non-Israeli ethnic background, use of epidural analgesia, nulliparity, shorter interval since last vaginal delivery, longer active phase and prolonged second stage. Prolonged second stage (> 40 minutes) and low parity were independent risk factors for perineal tears in a multivariable analysis.
Identifying women in specific subgroups at high risk for perineal lacerations may minimize perineal damage. Women with a prolonged second stage of labor and low parity are prone for spontaneous damage and therefore deserve special attention.
评估阴道分娩时自发性和医源性会阴损伤的可能危险因素。
对300例单胎妊娠37 - 42周且处于活跃期分娩的患者进行了一项前瞻性观察研究。入院时获取社会人口统计学数据、分娩情况和既往病史。在修复前及产后24小时评估会阴损伤情况。构建多元逻辑回归模型以研究自发性会阴裂伤的独立危险因素。
纳入的300名女性中，139名为初产妇。32%的产妇进行了会阴切开术（初产妇中为62%，经产妇中为6%）。28%的患者发生了需要缝合的自发性会阴撕裂。1%的患者发生了严重会阴撕裂（3级和4级）。未行会阴切开术组不良会阴结局的危险因素包括产妇年龄较小、非以色列族裔背景、使用硬膜外镇痛、初产、距上次阴道分娩时间较短、活跃期较长和第二产程延长。在多变量分析中，第二产程延长（> 40分钟）和低产次是会阴撕裂的独立危险因素。
识别处于会阴撕裂高风险特定亚组的女性可将会阴损伤降至最低。第二产程延长且产次低的女性易发生自发性损伤，因此值得特别关注。
