Kettle Chris, Tohill Susan
University Hospital of North Staffordshire (NHS Trust) and Staffordshire University, Stoke-on-Trent, UK.
BMJ Clin Evid. 2011 Apr 11;2011:1401.
Over 85% of women having a vaginal birth suffer some perineal trauma. Spontaneous tears requiring suturing are estimated to occur in at least a third of women in the UK and US, with anal sphincter tears in 0.5% to 7% of women. Perineal trauma can lead to long-term physical and psychological problems.
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of intrapartum surgical and non-surgical interventions on rates of perineal trauma? What are the effects of different methods and materials for primary repair of first- and second-degree tears and episiotomies? What are the effects of different methods and materials for primary repair of obstetric anal sphincter injuries (third- and fourth-degree tears)? We searched: Medline, Embase, The Cochrane Library, and other important databases up to March 2010 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
We found 38 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
In this systematic review we present information relating to the effectiveness and safety of the following interventions: active pushing, spontaneous pushing, and sustained breath-holding (Valsalva) method of pushing; continuous support during labour; conventional suturing; different methods and materials for primary repair of obstetric anal sphincter injuries; episiotomies (midline and mediolateral incisions); epidural analgesia; forceps; methods of delivery ("hands-on" method, "hands poised"); water births; non-suturing of muscle and skin (or perineal skin alone); passive descent in the second stage of labour; positions (supine or lithotomy positions, upright position during delivery); restrictive or routine use of episiotomy; sutures (absorbable synthetic sutures, catgut sutures, continuous sutures, interrupted sutures); and vacuum extraction.
超过85%经阴道分娩的女性会遭受某种会阴创伤。据估计，在英国和美国，至少三分之一的女性会出现需要缝合的自然撕裂伤，0.5%至7%的女性会出现肛门括约肌撕裂伤。会阴创伤可导致长期的身体和心理问题。
我们进行了一项系统评价，旨在回答以下临床问题：产时手术和非手术干预对会阴创伤发生率有何影响？不同方法和材料对一度和二度撕裂伤及会阴切开术进行一期修复有何影响？不同方法和材料对产科肛门括约肌损伤（三度和四度撕裂伤）进行一期修复有何影响？我们检索了：截至2010年3月的Medline、Embase、Cochrane图书馆及其他重要数据库（Clinical Evidence综述会定期更新，请查看我们的网站获取本综述的最新版本）。我们纳入了来自美国食品药品监督管理局（FDA）和英国药品和医疗产品监管局（MHRA）等相关组织的危害警示。
我们找到了38项符合我们纳入标准的系统评价、随机对照试验或观察性研究。我们对干预措施的证据质量进行了GRADE评估。
在本系统评价中，我们提供了以下干预措施有效性和安全性的相关信息：主动用力、自然用力以及持续屏气（瓦尔萨尔瓦）用力方法；分娩期间持续支持；传统缝合；不同方法和材料对产科肛门括约肌损伤进行一期修复；会阴切开术（中线和侧切）；硬膜外镇痛；产钳；分娩方式（“动手”方式、“准备好双手”）；水中分娩；肌肉和皮肤不缝合（或仅会阴皮肤不缝合）；第二产程被动下降；体位（仰卧或截石位、分娩时直立位）；限制性或常规使用会阴切开术；缝线（可吸收合成缝线、肠线缝线、连续缝线、间断缝线）；以及真空吸引。
