初产妇阴道分娩中限制性会阴切开术与常规会阴切开术的早期母体和新生儿并发症比较。
A comparison between early maternal and neonatal complications of restrictive episiotomy and routine episiotomy in primiparous vaginal delivery.
作者信息
Shahraki Azar Danesh, Aram Shahnaz, Pourkabirian Soodabeh, Khodaee Sepideh, Choupannejad Shekofeh
机构信息
Associate Professor, Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
出版信息
J Res Med Sci. 2011 Dec;16(12):1583-9.
BACKGROUND
Routine episiotomy is a controversial issue among gynecologists. The aim of this study was to compare early maternal and neonatal complications of restrictive episiotomy and routine episiotomy in primiparus vaginal delivery.
METHODS
In this descriptive cross-sectional study, two groups of primiparus normal vaginal delivery (NVD) cases with routine and restrictive episiotomy were studied. Immediately and in the first 24 and 48 hours after delivery, specific charts were used to compare the two groups in terms of perineal laceration size, neonatal Apgar score and post-delivery. For data analysis, SPSS was used to conduct student t-test and Kruskal-Wallis test. A p-value < 0.05 was considered significant.
RESULTS
Forty primiparus pregnant women were studied in each group. Episiotomy was performed in 7.5% of the restrictive group. Perineal laceration was measured as 3.68 ± 0.47 cm and 1.21 ± 1.1 in routine and restrictive episiotomy groups, respectively (p < 0.05). Intact perineum or first-degree laceration was seen in 80% of the restrictive group. However, second- and third-degree laceration were respectively observed in 75% and 15% of the routine episiotomy group (p < 0.05). Pain relief (immediately, 24 and 48 hours after delivery) was significantly higher in the restrictive group (p < 0.05). On the contrary, no significant difference in Apgar scores at the first and fifth minutes after birth was found between the two groups (p > 0.05).
CONCLUSIONS
Restrictive episiotomy results in low maternal complications. Therefore, avoiding routine episiotomy in unnecessary conditions would increase the rate of intact perineal and minor perineal trauma and reduce postpartum delivery pain with no adverse effects neither on maternal nor neonatal morbidities.
背景
常规会阴切开术在妇科医生中是一个有争议的问题。本研究的目的是比较初产妇阴道分娩中限制性会阴切开术和常规会阴切开术的早期母婴并发症。
方法
在这项描述性横断面研究中，对两组初产妇正常阴道分娩（NVD）病例进行了研究，一组采用常规会阴切开术，另一组采用限制性会阴切开术。在分娩后即刻以及产后24小时和48小时，使用特定图表对两组在会阴裂伤大小、新生儿阿氏评分和产后情况方面进行比较。数据分析采用SPSS进行学生t检验和Kruskal-Wallis检验。p值<0.05被认为具有统计学意义。
结果
每组研究了40例初产妇。限制性组7.5%进行了会阴切开术。常规会阴切开术组和限制性会阴切开术组的会阴裂伤分别测量为3.68±0.47厘米和1.21±1.1（p<0.05）。限制性组80%的会阴完整或为一度裂伤。然而，常规会阴切开术组分别有75%和15%的产妇出现二度和三度裂伤（p<0.05）。限制性组产后即刻、24小时和48小时的疼痛缓解情况明显更高（p<0.05）。相反，两组出生后第1分钟和第5分钟的阿氏评分无显著差异（p>0.05）。
结论
限制性会阴切开术导致的产妇并发症较低。因此，在不必要的情况下避免常规会阴切开术将提高会阴完整和轻微会阴创伤的发生率，并减轻产后疼痛，且对母婴发病率均无不良影响。
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