Rodriguez Alexander, Arenas Edgar A, Osorio Alba L, Mendez Omar, Zuleta John J
Department of Obstetrics and Gynecology, San Vicente de Paul Hospital, Antioquia University Medical School, Medellín, Colombia.
Am J Obstet Gynecol. 2008 Mar;198(3):285.e1-4. doi: 10.1016/j.ajog.2007.11.007. Epub 2008 Jan 25.
The purpose of this study was to determine whether selective midline episiotomy contributes to the prevention of third- or fourth-degree perineal lacerations.
A randomized controlled clinical trial was performed with 446 nulliparous women with deliveries after 28 weeks of pregnancy. Patients were randomized to undergo either routine episiotomy or selective episiotomy. In the selective episiotomy group, episiotomies were performed only in cases of imminent lacerations, fetal distress, or forceps delivery.
In the group of 223 patients who underwent routine episiotomy, 32 (14.3%) had third- or fourth-degree perineal lacerations, as compared to 15 (6.8%) in the group of 222 patients undergoing selective episiotomy (relative risk, 2.12; 95% confidence interval, 1.18-3.81). Only reduction in third-degree lacerations was significant when analyzed separately. Moreover, periurethral, labia minora, and superficial vaginal lacerations were significantly more frequent in the selective episiotomy group.
The policy of performing selective midline episiotomy in nulliparous patients results in a reduction in the risk of third-degree perineal lacerations.
本研究旨在确定选择性会阴正中切开术是否有助于预防三度或四度会阴裂伤。
对446例妊娠28周后分娩的初产妇进行了一项随机对照临床试验。患者被随机分为接受常规会阴切开术或选择性会阴切开术。在选择性会阴切开术组中，仅在即将发生裂伤、胎儿窘迫或产钳分娩的情况下进行会阴切开术。
在接受常规会阴切开术的223例患者中，32例（14.3%）发生了三度或四度会阴裂伤，而在接受选择性会阴切开术的222例患者中，这一比例为15例（6.8%）（相对风险，2.12；95%置信区间，1.18 - 3.81）。单独分析时，仅三度裂伤的减少具有显著性。此外，选择性会阴切开术组的尿道周围、小阴唇和阴道浅表裂伤明显更为常见。
对初产妇实施选择性会阴正中切开术的策略可降低三度会阴裂伤的风险。
