Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, Luebeck, Germany.
Arch Gynecol Obstet. 2010 Jan;281(1):59-64. doi: 10.1007/s00404-009-1063-7. Epub 2009 Mar 31.
To identify risk factors for the development of severe perineal lacerations and to give recommendations for their prevention in nulliparous women.
A retrospective case-control analysis of deliveries at our University Hospital was performed. Multiparae, Caesarean sections, twin pregnancies, fetal breech position and preterm deliveries were excluded. Univariate and multivariate step forward regression analyses were performed; correlations between contributors were further analyzed by Spearman Rank Correlation. Differences between the degree of lacerations and maternal age were further analyzed with Friedman ANOVA followed by Dunn's Multiple Comparison Test.
A total of 2,967 deliveries fitted our inclusion criteria, 50 (1.7%) mothers had higher-grade lacerations. Mediolateral and median episiotomy, advanced maternal age, vaginal operative delivery, higher fetal birth weight and abnormal cephalic presentation were associated with severe lacerations.
Advanced maternal age plays an important role in the development of anal sphincter tears in nulliparous women. Episiotomy and operative vaginal deliveries should be restrictively performed when possible. To identify further preventive approaches in patients with accumulated risk factors prospective randomized studies are needed.
确定初产妇发生严重会阴裂伤的危险因素，并为预防初产妇会阴裂伤提供建议。
对我院分娩的产妇进行回顾性病例对照分析。排除多产妇、剖宫产、双胎妊娠、胎儿臀位和早产。进行单因素和多因素逐步向前回归分析；通过 Spearman 秩相关分析进一步分析各因素之间的相关性。进一步采用 Friedman ANOVA 分析裂伤程度与产妇年龄之间的差异，然后采用 Dunn's 多重比较检验进行分析。
共纳入 2967 例符合条件的分娩，50 例（1.7%）产妇发生严重裂伤。会阴正中切开术和会阴侧切术、产妇高龄、阴道手术分娩、胎儿出生体重大和胎头异常是发生严重会阴裂伤的相关因素。
产妇高龄是初产妇发生肛门括约肌撕裂的重要因素。当可行时，应限制会阴切开术和阴道手术分娩。对于有累积危险因素的患者，需要前瞻性随机研究来确定进一步的预防措施。
