Department of Nursing Science, University of Kuopio, Kuopio University Hospital, PL 1777, 70211 Kuopio, Finland.
Midwifery. 2010 Jun;26(3):348-56. doi: 10.1016/j.midw.2008.07.007. Epub 2008 Sep 18.
to describe and explain the short-term effects of lateral episiotomy, and determine the factors associated with more/less common use of episiotomy.
prospective cross-sectional survey using a postal questionnaire.
the study was conducted at two university hospitals and one regional hospital in Finland between October and December 2006. The hospitals were chosen using cluster sampling. The sample consisted of 1000 vaginal births, and data were collected using questionnaires which were completed by midwives or student midwives. The overall response rate was 88%.
midwives or student midwives who took care of the women in labour provided information about childbearing women (n=879), obstetric factors and details of staff experience.
episiotomies were more common among primiparous than multiparous women (55% vs 12%, p0.001). More common use of episiotomy was also associated with induced births compared with spontaneous births in primiparous women (66% vs 53%, p=0.036), assisted vaginal births in all women (89% vs 25%, p0.001), and a prolonged active second stage of labour and epidural analgesia (17% vs 10%, p=0.036) in multiparous women. Correspondingly, episiotomies were less common among primiparous (44% vs 57%, p=0.041) and multiparous (7% vs 16%, p=0.003) women using spontaneous pushing compared with coached pushing. In the active second stage of labour, alternative birth positions (lateral, squatting, all fours, sitting) were associated with less common use of episiotomy than half-sitting or lithotomy positions among primiparous women (22% vs 48% vs 85%, p0.001). There were no differences between primiparous women with and without episiotomy in low Apgar score at 1minute (10.6% vs 6.4%, p=0.131) or 5minutes (1.8% vs 1.1%, p=0.557), or between multiparous women with and without episiotomy in low Apgar score at 1minute (1.9% vs 2.2%, p=0.855) or 5minutes (0% vs 0.5%, p=0.603). There were more first- and second-degree perineal injuries as well as injuries to the vagina, labia minora and urethra in births performed without episiotomies among primiparous women (p0.001). Correspondingly, third-degree perineal injuries were more common if episiotomy was performed in both primiparous (2.2% vs 1.6%) and multiparous women (3.7% vs 0%). The maternity hospital was the most significant determinant of the episiotomy rate (odds ratio 1 vs 1.9 vs 2.6, p=0.049).
episiotomy rates can be reduced without causing harm to women or newborn babies. Episiotomies can be avoided if induction and vacuum assistance are used sparingly, and if spontaneous pushing techniques and alternative birth positions (lateral, sitting, squatting, all fours) are used more often during labour.
描述并解释会阴侧切术的短期影响，并确定与侧切术更常/不常使用相关的因素。
使用邮寄问卷进行前瞻性横断面调查。
该研究于 2006 年 10 月至 12 月在芬兰的两家大学医院和一家地区医院进行。医院采用聚类抽样选择。样本包括 1000 名阴道分娩的产妇，由助产士或学生助产士通过问卷收集信息。总体应答率为 88%。
负责产妇分娩的助产士或学生助产士提供了有关产妇（n=879）、产科因素和工作人员经验详细信息的信息。
初产妇的会阴切开术比经产妇更常见（55%比 12%，p0.001）。初产妇中，与自发性分娩相比，诱导分娩（66%比 53%，p=0.036）、所有产妇的辅助阴道分娩（89%比 25%，p0.001）以及活跃第二产程延长和硬膜外镇痛（17%比 10%，p=0.036）与会阴切开术更常使用相关。相应地，与 coached pushing 相比，primiparous（44%比 57%，p=0.041）和 multiparous（7%比 16%，p=0.003）妇女中自发性用力分娩时会阴切开术更少见。在活跃的第二产程中，与半坐式或截石位相比，替代分娩姿势（侧卧位、蹲位、四肢位、坐位）与 primiparous 妇女会阴切开术的使用较少相关（22%比 48%比 85%，p0.001）。初产妇中会阴切开术与无会阴切开术的 1 分钟（10.6%比 6.4%，p=0.131）和 5 分钟（1.8%比 1.1%，p=0.557）低 Apgar 评分之间无差异，而 multiparous 妇女中会阴切开术与无会阴切开术的 1 分钟（1.9%比 2.2%，p=0.855）和 5 分钟（0%比 0.5%，p=0.603）低 Apgar 评分之间也无差异。在 primiparous 妇女中，不进行会阴切开术的分娩中会有更多的 1 度和 2 度会阴裂伤以及阴道、小阴唇和尿道损伤（p0.001）。相应地，如果在 primiparous（2.2%比 1.6%）和 multiparous 妇女（3.7%比 0%）中进行会阴切开术，则 3 度会阴裂伤更为常见。产妇医院是会阴切开率的最显著决定因素（优势比 1 比 1.9 比 2.6，p=0.049）。
在不伤害妇女和新生儿的情况下，可以降低会阴切开术的发生率。如果谨慎使用诱导和真空辅助分娩，以及更频繁地使用自发性用力技术和替代分娩姿势（侧卧位、坐位、蹲位、四肢位），可以避免会阴切开术。
