Beucher G
CHU de Caen, service de gynécologie obstétrique et médecine de la reproduction, avenue Clémenceau, 14033 Caen cedex, France.
J Gynecol Obstet Biol Reprod (Paris). 2008 Dec;37 Suppl 8:S244-59. doi: 10.1016/S0368-2315(08)74762-8.
Operative vaginal delivery significantly increases the risk of anal sphincter injury compared with spontaneous vaginal delivery, particularly when an instrumental application at high station, persistent occipital posterior presentation and/or macrosomia are associated. Risks of vaginal tears, postpartum haemorrhage and urinary retention appear to be increased compared with spontaneous vaginal delivery. There is no evidence that one type of forceps is less safe than another. Different vacuum extractors (soft, rigid and single-use instruments) have similar maternal outcomes. A risk of anal incontinence in the first year postpartum is associated with operative vaginal delivery, particularly forceps. Operative vaginal delivery also appears to increase the risk of occult anal sphincter injury regardless of the instrument used, but does not appear to be associated with the risk of postpartum urinary incontinence and genital prolapse compared with spontaneous vaginal delivery. It does, however, increase the risks of perineal pain, postpartum dyspareunia and sexual disorders compared with spontaneous vaginal delivery, particularly in cases of perineal tears.
与自然阴道分娩相比，手术助产显著增加了肛门括约肌损伤的风险，尤其是当高位器械助产、持续性枕后位和/或巨大儿同时存在时。与自然阴道分娩相比，阴道撕裂、产后出血和尿潴留的风险似乎有所增加。没有证据表明一种产钳比另一种更不安全。不同类型的真空吸引器（软质、硬质和一次性器械）对产妇的结局相似。产后第一年出现肛门失禁的风险与手术助产有关，尤其是产钳助产。无论使用何种器械，手术助产似乎也会增加隐匿性肛门括约肌损伤的风险，但与自然阴道分娩相比，似乎与产后尿失禁和生殖器脱垂的风险无关。然而，与自然阴道分娩相比，它确实会增加会阴疼痛、产后性交困难和性功能障碍的风险，尤其是在会阴撕裂的情况下。
