Fritel X, Schaal J-P, Fauconnier A, Bertrand V, Levet C, Pigné A
Service de gynécologie-obstétrique, hôpital Rothschild, Assistance publique-Hôpitaux de Paris (AP-HP), université Pierre-et-Marie-Curie, 33, boulevard de Picpus, 75012 Paris, France.
Gynecol Obstet Fertil. 2008 Oct;36(10):991-7. doi: 10.1016/j.gyobfe.2008.07.009. Epub 2008 Sep 17.
To compare two policies for episiotomy: restrictive and systematic.
It is a quasi-randomised comparative study between two French university hospitals with contrasting episiotomy policies: one using it restrictively and the second routinely. Population included 774 nulliparous women delivered during 1996 of a singleton in cephalic presentation at a term of 37-41 weeks. A questionnaire was mailed four years after delivery. Sample size was calculated to allow showing a 10% difference in the prevalence of urinary incontinence with 80% power. Main outcome measures were urinary incontinence, anal incontinence, perineal pain and pain during intercourse.
We received 627 responses (81%), 320 from women delivered under the restrictive policy, 307 from women delivered under the routine policy. In the restrictive group, 186 (49%) deliveries included mediolateral episiotomies and in the routine group, 348 (88%). Four years after the first delivery, the groups did not differ in the prevalence of urinary incontinence (26% versus 32%), perineal pain (6% versus 8%), or pain during intercourse (18% versus 21%). Anal incontinence was less prevalent in the restrictive group (11% versus 16%). The difference was significant for flatus (8% versus 13%) but not for faecal incontinence (3% for both groups). Logistic regression confirmed that a policy of routine episiotomy was associated with a risk of anal incontinence nearly twice as high as the risk associated with a restrictive policy (OR=1.84, 95 % CI :1.05-3.22).
A policy of routine episiotomy does not protect against urinary or anal incontinence four years after first delivery.
比较两种会阴切开术策略：限制性策略和常规性策略。
这是一项在两家法国大学医院之间进行的半随机对照研究，两家医院的会阴切开术策略截然不同：一家采用限制性策略，另一家常规使用。研究对象包括1996年分娩的774名单胎头位、孕37 - 41周的初产妇。产后四年邮寄问卷调查。计算样本量以确保在80%的检验效能下，能显示出尿失禁患病率有10%的差异。主要观察指标为尿失禁、肛门失禁、会阴疼痛和性交疼痛。
我们收到了627份回复（81%），其中320份来自采用限制性策略分娩的女性，307份来自采用常规策略分娩的女性。在限制性组，186例（49%）分娩实施了会阴侧切术，常规组为348例（88%）。首次分娩四年后，两组在尿失禁患病率（26%对32%）、会阴疼痛（6%对8%）或性交疼痛（18%对21%）方面无差异。限制性组肛门失禁的患病率较低（11%对16%）。在排气方面差异显著（8%对13%），但在大便失禁方面无差异（两组均为3%）。逻辑回归证实，常规会阴切开术策略导致肛门失禁的风险几乎是限制性策略的两倍（比值比=1.84，95%置信区间：1.05 - 3.22）。
首次分娩四年后，常规会阴切开术策略并不能预防尿失禁或肛门失禁。
