Barbier A, Poujade O, Fay R, Thiébaugeorges O, Levardon M, Deval B
Service de Gynécologie-Obstétrique, Maternité Universitaire de Nancy, 10, rue du Docteur-Heydenreich, 54000 Nancy, France.
Gynecol Obstet Fertil. 2007 Feb;35(2):101-6. doi: 10.1016/j.gyobfe.2006.12.017. Epub 2007 Feb 7.
Primiparity has been identified as the main risk factor of type 3 and 4 perineal injuries The purpose of our study, according to a population-based observational study, was to identify other clinical risk factors for lesions during vaginal delivery.
Two groups have been compared. Group A or study group (n=63) was defined as parturients with three or four-degree perineal tears. Group B or control group (n=67) included women who delivered vaginally without any perineal lesion during the same period. Characteristics of the population were compared: maternal age, race, maternal weight, BMI (Body Mass Index), parity, mode of anaesthesia, gestational age, post maturity, length of labor, fetal weight, mode of delivery (assisted or not). Specific characteristics were also compared, obesity, shoulder dystocia, type of presentation, episiotomy and dose of ocytocin.
Primiparity was significantly associated with higher frequency of sphincter lacerations (71 vs 43%, p=0.001). The patients of group A were with significantly higher weight than the patients of control group (67 vs 63 kg, p=0.036). Futhermore the BMI was different in the two groups (25,6 vs 23,4, p=0.003). There was a significant difference according to the length of the second part of labor (68 vs 48 min, p=0.037) and the posterior variety (32 vs 4%, p<0.001). The occurrence of shoulder dystocia was only just significant (6 vs 0%, p=0.052). Assisted-extraction is highly associated with perineal injuries (44 vs 1%, p<0.001). Futhermore the instrument has been concerned by the difference: Tarnier's forceps-assisted extraction (14 vs 1%, p=0.003), Suzor's forceps-assisted extraction (16 vs 0%, p=0.0005), Thierry's spatula-assisted extraction (14 vs 0%, p=0,0005). The association forceps and episiotomy has been found with higher frequency of perineal injury (43 vs 1%, p<0,0001). There were no difference between the 2 groups according fetal characteristics, type of analgesia, maternal age, gestational age, post-maturity or dose of ocytocin.
Primiparity is not the only risk factor of perineal injuries. Other risk factors have been found: assisted-extraction, occiput posterior fetal head position, and association episiotomy and assisted-extraction. Black origin seems to be protective.
初产被确定为3度和4度会阴损伤的主要危险因素。根据一项基于人群的观察性研究，我们研究的目的是确定阴道分娩时损伤的其他临床危险因素。
比较了两组。A组或研究组（n = 63）被定义为会阴三度或四度撕裂的产妇。B组或对照组（n = 67）包括同期阴道分娩且无任何会阴损伤的女性。比较了人群的特征：产妇年龄、种族、产妇体重、体重指数（BMI）、产次、麻醉方式、孕周、过期产、产程长度、胎儿体重、分娩方式（是否助产）。还比较了特定特征，肥胖、肩难产、胎位、会阴切开术和缩宫素剂量。
初产与括约肌撕裂的较高发生率显著相关（71%对43%，p = 0.001）。A组患者的体重显著高于对照组患者（67千克对63千克，p = 0.036）。此外，两组的BMI不同（25.6对23.4，p = 0.003）。根据第二产程的长度（68分钟对48分钟，p = 0.037）和枕后位（32%对4%，p < 0.001）存在显著差异。肩难产的发生率仅具有统计学意义（6%对0%，p = 0.052）。助产牵引与会阴损伤高度相关（44%对1%，p < 0.001）。此外，器械方面也存在差异：塔尼尔产钳助产牵引（14%对1%，p = 0.003）、苏佐产钳助产牵引（16%对0%，p = 0.0005）、蒂埃里刮匙助产牵引（14%对0%，p = 0.0005）。发现产钳与会阴切开术联合使用时会阴损伤的发生率更高（43%对1%，p < 0.0001）。两组在胎儿特征、镇痛类型（应为“镇痛方式”）、产妇年龄、孕周、过期产或缩宫素剂量方面无差异。
初产不是会阴损伤的唯一危险因素。还发现了其他危险因素：助产牵引、枕后位胎儿头部位置以及会阴切开术与助产牵引联合使用。黑人血统似乎具有保护作用。 （注：原文中“type of analgesia”翻译为“镇痛类型”可能有误，结合语境推测应为“镇痛方式”，翻译时已按推测内容进行了修正。）
