Department of Family and Community Medicine, University of New Mexico School of Medicine, MSC09 5040, 2400 Tucker NW, Albuquerque, NM 87131, USA.
Birth. 2009 Dec;36(4):283-8. doi: 10.1111/j.1523-536X.2009.00355.x.
Perineal pain is common after childbirth. We studied the effect of genital tract trauma, labor care, and birth variables on the incidence of pain in a population of healthy women exposed to low rates of episiotomy and operative vaginal delivery.
A prospective study of genital trauma at birth and assessment of postpartum perineal pain and analgesic use was conducted in 565 midwifery patients. Perineal pain was assessed using the present pain intensity (PPI) and visual analog scale (VAS) components of the validated short-form McGill pain scale. Multivariate logistic regression examined which patient characteristics or labor care measures were significant determinants of perineal pain and use of analgesic medicines.
At hospital discharge, women with major trauma reported higher VAS pain scores (2.16 +/- 1.61 vs 1.48 +/- 1.40; p < 0.001) and were more likely to use analgesic medicines (76.3 vs 23.7%, p = 0.002) than women with minor or no trauma. By 3 months, average VAS scores were low in each group and not significantly different. Perineal pain at the time of discharge was associated in univariate analysis with higher education level, ethnicity (non-Hispanic white), nulliparity, and longer length of active maternal pushing efforts. In a multivariate model, only trauma group and length of active pushing predicted the pain at hospital discharge. In women with minor or no trauma, only length of the active part of second stage labor had a positive relationship with pain. In women with major trauma, the length of active second stage labor had no independent effect on the level of pain at discharge beyond its effect on the incidence of major trauma.
Women with spontaneous perineal trauma reported very low rates of postpartum perineal pain. Women with major trauma reported increased perineal pain compared with women who had no or minor trauma; however, by 3 months postpartum this difference was no longer present. In women with minor or no perineal trauma, a longer period of active pushing was associated with increased perineal pain.
产后会阴疼痛很常见。我们研究了生殖道创伤、分娩护理和分娩变量对暴露于低会阴切开率和阴道助产分娩率的健康女性人群中疼痛发生率的影响。
对 565 名助产患者进行了分娩时生殖道创伤的前瞻性研究，并评估了产后会阴疼痛和镇痛药使用情况。使用经过验证的简短 McGill 疼痛量表的 PPI 和 VAS 分量表评估会阴疼痛。多变量逻辑回归分析了哪些患者特征或分娩护理措施是会阴疼痛和使用镇痛药的重要决定因素。
在出院时，有严重创伤的女性报告的 VAS 疼痛评分更高（2.16±1.61 比 1.48±1.40；p<0.001），并且更有可能使用镇痛药（76.3 比 23.7%，p=0.002）比轻微或无创伤的女性。在 3 个月时，每组的平均 VAS 评分均较低，且无显著差异。出院时的会阴疼痛在单变量分析中与较高的教育水平、种族（非西班牙裔白人）、初产妇和较长的主动产妇推挤时间有关。在多变量模型中，只有创伤组和主动推挤时间预测了出院时的疼痛。在有轻微或无创伤的女性中，只有第二产程活跃部分的长度与疼痛呈正相关。在有严重创伤的女性中，第二产程活跃时间的长度对出院时疼痛水平的独立影响超过了对严重创伤发生率的影响。
自发性会阴创伤的女性报告产后会阴疼痛的发生率非常低。有严重创伤的女性报告的会阴疼痛比没有或轻微创伤的女性增加；然而，在产后 3 个月时，这种差异不再存在。在有轻微或无会阴创伤的女性中，较长时间的主动推挤与增加的会阴疼痛相关。
