Department of Midwifery Science, AVAG and the EMGO Institute of Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands.
Birth. 2013 Dec;40(4):247-55. doi: 10.1111/birt.12060.
To examine the episiotomy incidence and determinants and outcomes associated with its use in primary care midwifery practices.
Secondary analysis of two prospective cohort studies (n = 3,404).
The episiotomy incidence was 10.8 percent (20.9% for nulliparous and 6.3% for parous women). Episiotomy was associated with prolonged second stage of labor (adj. OR 12.09 [95% CI 6.0-24.2] for nulliparous and adj. OR 2.79 [1.7-4.6] for parous women) and hospital birth (adj. OR 1.75 [1.2-2.5] for parous women). Compared with episiotomy, perineal tears were associated with a lower rate of postpartum hemorrhage in parous women (adj. OR 0.58 [0.4-0.9]). Fewer women with perineal tears reported perineal discomfort (adj. OR 0.35 [0.2-0.6] for nulliparous and adj. OR 0.22 [0.1-0.3] for parous women). Among nulliparous women episiotomy was performed most frequently for prolonged second stage of labor (38.8%) and among parous women for history of episiotomy or prevention of major perineal trauma (21.1%).
The incidence of episiotomy is high compared with some low-risk settings in other Western countries. Episiotomy was associated with higher rates of adverse maternal outcomes. Restricted use of episiotomy is likely to be beneficial for women.
检查初级保健助产实践中会阴切开术的使用率及其相关决定因素和结局。
对两项前瞻性队列研究（n=3404）进行二次分析。
会阴切开术的发生率为 10.8%（初产妇为 20.9%，经产妇为 6.3%）。会阴切开术与第二产程延长有关（初产妇的校正比值比[OR]为 12.09[95%CI 6.0-24.2]，经产妇的校正 OR 为 2.79[1.7-4.6]），并与医院分娩有关（经产妇的校正 OR 为 1.75[1.2-2.5]）。与会阴切开术相比，会阴裂伤与经产妇产后出血发生率较低相关（校正 OR 为 0.58[0.4-0.9]）。会阴裂伤的女性报告会阴不适的比例较低（初产妇的校正 OR 为 0.35[0.2-0.6]，经产妇的校正 OR 为 0.22[0.1-0.3]）。在初产妇中，会阴切开术最常因第二产程延长而施行（38.8%），在经产妇中则因会阴切开术史或防止严重会阴创伤而施行（21.1%）。
与其他一些西方国家的低危环境相比，会阴切开术的发生率较高。会阴切开术与产妇不良结局发生率较高有关。限制会阴切开术的使用可能对女性有益。
