Williams Meredith K, Chames Mark C
Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Michigan Health System, Ann Arbor, MI, USA.
Am J Obstet Gynecol. 2006 Sep;195(3):755-9. doi: 10.1016/j.ajog.2006.06.085.
The purpose of this study was to identify risk factors that are associated with the breakdown of perineal laceration repair in the postpartum period.
We conducted a retrospective, case-control study to review perineal laceration repair breakdown in patients who were delivered between September 1995 and February 2005 at the University of Michigan. Bivariate analysis with chi-square test and t-test and stepwise logistic regression analysis were performed.
Fifty-nine cases and 118 control deliveries were identified from a total of 14,124 vaginal deliveries. Risk factors were longer second stage of labor (142 vs 87 minutes; P = .001), operative vaginal delivery (odds ratio, 3.6; 95% CI, 1.8-7.3), mediolateral episiotomy (odds ratio, 6.9; 95% CI, 2.6-18.7), third- or fourth-degree laceration (odds ratio, 3.1; 95% CI, 1.5-6.4), and meconium-stained amniotic fluid (odds ratio, 3.0; 95% CI, 1.1-7.9). Previous vaginal delivery was protective (odds ratio, 0.38; 95% CI, 0.18-0.84). Logistic regression showed the most significant factor to be an interaction between operative vaginal delivery and mediolateral episiotomy (odd ratio, 6.36; 95% CI, 2.18-18.57).
The most significant events were mediolateral episiotomy, especially in conjunction with operative vaginal delivery, third- and fourth-degree lacerations, and meconium.
本研究旨在确定与产后会阴裂伤修补失败相关的危险因素。
我们进行了一项回顾性病例对照研究，以回顾1995年9月至2005年2月在密歇根大学分娩的患者会阴裂伤修补失败情况。采用卡方检验和t检验进行双变量分析，并进行逐步逻辑回归分析。
在总共14124例阴道分娩中，确定了59例病例和118例对照分娩。危险因素包括第二产程延长（142分钟对87分钟；P = 0.001）、阴道助产（比值比，3.6；95%可信区间，1.8 - 7.3）、会阴侧切（比值比，6.9；95%可信区间，2.6 - 18.7）、三度或四度裂伤（比值比，3.1；95%可信区间，1.5 - 6.4）以及羊水粪染（比值比，3.0；95%可信区间，1.1 - 7.9）。既往阴道分娩具有保护作用（比值比，0.38；95%可信区间，0.18 - 0.84）。逻辑回归显示，最显著的因素是阴道助产与会阴侧切之间的相互作用（比值比，6.36；95%可信区间，2.18 - 18.57）。
最显著的因素是会阴侧切，尤其是与阴道助产、三度和四度裂伤以及胎粪有关。
