Gossett Dana R, Dunsmoor Su Rebecca
Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
J Reprod Med. 2008 Oct;53(10):803-8.
Episiotomy practice in the United States has changed dramatically over the past 20 years, and recent studies have questioned the utility of routine episiotomy. Our objective was to evaluate current episiotomy practice in a community hospital.
We reviewed vaginal deliveries at a community hospital from January 1, 2004, to December 31, 2005. Maternal,fetal, labor and provider data were collected. Data were analyzed with t test, chi2 and logistic regression.
A total of 2,959 deliveries by 17 practitioners were evaluated. The episiotomy rate increased for younger patients, with estimated fetal weight > 4,000 g, when presentation was not occiput anterior and with decreasing parity. Provider characteristics, such as a greater number of years in practice or when the delivering physician was not the outpatient physician, increased episiotomy rates. The overall episiotomy rate declined from 20.6% to 17.7% during the study; however, this did not reach statistical significance, and some practitioners had unchanged or increased rates.
Practitioner characteristics were the strongest predictors of episiotomy. Overall, the rate at this community hospital was within published recommendations, but wide variations in practice (range, 2-43%) suggest that education needs to target community physicians remote from training to ensure that all women receive optimal, evidence-based delivery care.
在过去20年里，美国的会阴切开术实施情况发生了巨大变化，近期研究对常规会阴切开术的效用提出了质疑。我们的目的是评估一家社区医院当前的会阴切开术实施情况。
我们回顾了2004年1月1日至2005年12月31日期间一家社区医院的阴道分娩情况。收集了产妇、胎儿、分娩及医护人员的数据。数据采用t检验、卡方检验和逻辑回归进行分析。
共评估了17名医护人员的2959例分娩情况。会阴切开率在年轻患者、估计胎儿体重>4000g、胎位非枕前位以及经产次数减少时有所增加。医护人员的特征，如从业年限较长或接生医生不是门诊医生时，会阴切开率会增加。在研究期间，总体会阴切开率从20.6%降至17.7%；然而，这未达到统计学显著性，且一些医护人员的会阴切开率未变或有所增加。
医护人员的特征是会阴切开术最强的预测因素。总体而言，这家社区医院的会阴切开率在已发表的建议范围内，但实施情况差异很大（范围为2%-43%），这表明需要针对远离培训的社区医生开展教育，以确保所有女性都能获得最佳的、基于证据的分娩护理。
