Ray Camille Le, Audibert François, Cabrol Dominique, Goffinet François
Département d'obstétrique et de gynécologie, CHU Sainte-Justine, Université de Montréal, Montréal (Québec); Maternité Port-Royal, Hôpital Cochin Saint-Vincent-de-Paul, Université Paris Descartes, Assistance Publique - Hôpitaux de Paris, Paris.
Département d'obstétrique et de gynécologie, CHU Sainte-Justine, Université de Montréal, Montréal (Québec).
J Obstet Gynaecol Can. 2009 Nov;31(11):1035. doi: 10.1016/S1701-2163(16)34348-1.
To study how differences in birth management can influence the frequency and types of perineal lesions.
We compared outcomes and obstetric practices during labour and birth in low-risk primiparous women in two maternity units: one Canadian (maternitA Sainte-Justine, Montreal, Quebec), one French (maternité Cochin-Port-Royal, Paris). We compared the occurrence of perineal lesions--episiotomy and severe perineal tear--in these two maternity units according to delivery method. Furthermore, we studied risk factors for perineal lesions using univariate and multivariate analyses.
Among the 1044 births in Montreal and the 1154 births in Paris, the Caesarian-section rate, about 19%, was comparable in both maternity units. Among primiparous women who had a vaginal delivery, the rate of instrumental extraction was higher in the French unit than in the Canadian one (28.2% vs. 21.5%, P < 0.001). The rate of episiotomy was significantly higher in the French unit (65.9%) than in the Canadian one (23.2%), whether the vaginal delivery was spontaneous (OR adjusted = 5.8 [4.4-7.7]) or assisted (OR adjusted = 120.2 [61.0-23.1]). The rate of severe perineal tear was significantly higher in the Canadian maternity unit (11.1%) than in the French one (1.3%), whether the vaginal delivery was spontaneous (OR adjusted = 17.4 [2.4-128.7]) or assisted (OR adjusted = 45.7 [6.1-343.4]).
The significant differences in episiotomy and severe perineal tear rates observed in low-risk primiparous women are in part due to the different methods used to manage delivery in these two maternity units, particularly with regard to the angle of incision during episiotomy: median in Canada and median-lateral in France.
研究分娩管理差异如何影响会阴损伤的频率和类型。
我们比较了两个产科病房中低风险初产妇分娩期间及分娩时的结局和产科操作：一个在加拿大（魁北克省蒙特利尔市圣朱斯汀妇产医院），一个在法国（巴黎科钦 - 皇家妇产医院）。我们根据分娩方式比较了这两个产科病房会阴损伤（会阴切开术和严重会阴撕裂）的发生率。此外，我们使用单因素和多因素分析研究了会阴损伤的危险因素。
在蒙特利尔的1044例分娩和巴黎的1154例分娩中，两个产科病房的剖宫产率相当，约为19%。在经阴道分娩的初产妇中，法国病房器械助产率高于加拿大病房（28.2%对21.5%，P<0.001）。无论阴道分娩是自然分娩（校正比值比=5.8[4.4 - 7.7]）还是助产分娩（校正比值比=120.2[61.0 - 23.1]），法国病房会阴切开术的发生率（65.9%）显著高于加拿大病房（23.2%）。无论阴道分娩是自然分娩（校正比值比=17.4[2.4 - 128.7]）还是助产分娩（校正比值比=45.7[6.1 - 343.4]），加拿大产科病房严重会阴撕裂的发生率（11.1%）显著高于法国病房（1.3%）。
在低风险初产妇中观察到的会阴切开术和严重会阴撕裂率的显著差异部分归因于这两个产科病房不同的分娩管理方法，特别是在会阴切开术的切口角度方面：加拿大是正中切口，法国是正中 - 侧切。
