Department of Obstetrics and Gynaecology, Norfolk and Norwich University Hospital, Norwich, UK.
Eur J Obstet Gynecol Reprod Biol. 2010 Jun;150(2):142-6. doi: 10.1016/j.ejogrb.2010.03.002. Epub 2010 Mar 31.
To analyse the significance of risk factors and the role of episiotomy in preventing obstetric anal sphincter injury at vaginal delivery.
This is a retrospective cross-sectional study in the Norfolk and Norwich University Hospital in the UK. All caesarean sections and non-vertex presentations were excluded, which resulted in a study population of 10,314 deliveries. Obstetric anal sphincter injury (OASI) was defined as third or fourth degree tears to the anal sphincter muscles, with or without a tear involving the anal mucosa. First a univariate analysis was done to identify factors that had a significant association with OASI. Factors included parity, age, gestation, labour induction method, duration of second stage, use of epidural analgesia, episiotomy, method of delivery, time and month of delivery, and birth weight. All factors were then combined in a multivariate logistic regression analysis. The multivariate analysis was then repeated including only factors that had a significant association with OASI in the univariate analysis. Adjusted odds ratios with 95% confidence intervals (CI) were calculated.
The frequency of anal sphincter lacerations was 3.2%. There were statistically significant associations between an increased incidence of OASI and parity, birth weight, method of delivery and shoulder dystocia. Women giving birth without a mediolateral episiotomy were 1.4 times more likely to experience OASI (95% CI 1.021-1.983). Interestingly, the incidence of OASI has risen between 2005 and 2007.
Parity, age, birth weight, method of delivery and shoulder dystocia are strongly associated with obstetric anal sphincter injury. Mediolateral episiotomy appears to be protective against OASI but a randomised controlled trial would be needed to confirm this. The rising incidence of OASI after normal vaginal deliveries may be related to adoption of the hands off technique or increased identification of tears.
分析风险因素的意义以及会阴侧切术在预防阴道分娩时发生产科肛门括约肌损伤中的作用。
这是英国诺福克和诺维奇大学医院的一项回顾性横断面研究。所有剖宫产术和非头位分娩均被排除在外，因此研究人群为 10314 例分娩。产科肛门括约肌损伤（OASI）定义为肛门括约肌肌肉三度或四度撕裂，伴有或不伴有肛门黏膜撕裂。首先进行单因素分析，以确定与 OASI 有显著关联的因素。这些因素包括产次、年龄、孕周、分娩诱导方法、第二产程持续时间、硬膜外镇痛的使用、会阴侧切术、分娩方式、分娩时间和月份以及出生体重。然后将所有因素纳入多变量逻辑回归分析。多变量分析再次重复，仅包括单因素分析中与 OASI 有显著关联的因素。计算调整后的比值比（95%置信区间[CI]）。
肛门括约肌裂伤的发生率为 3.2%。OASI 的发生率与产次、出生体重、分娩方式和肩难产显著相关。未行会阴正中切开术分娩的女性发生 OASI 的可能性增加 1.4 倍（95%CI 1.021-1.983）。有趣的是，2005 年至 2007 年间，OASI 的发生率有所上升。
产次、年龄、出生体重、分娩方式和肩难产与产科肛门括约肌损伤密切相关。会阴侧切术似乎可以预防 OASI，但需要进行随机对照试验来证实这一点。正常阴道分娩后 OASI 的发生率上升可能与采用不干预技术或更多地识别撕裂有关。
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