阴道助产术中严重会阴裂伤：枕后位的影响
Severe perineal laceration during operative vaginal delivery: the impact of occiput posterior position.
作者信息
Hirsch E, Elue R, Wagner A, Nelson K, Silver R K, Zhou Y, Adams M G
机构信息
1] Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL, USA [2] Department of Obstetrics and Gynecology, The University of Chicago, Chicago, IL, USA.
Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL, USA.
出版信息
J Perinatol. 2014 Dec;34(12):898-900. doi: 10.1038/jp.2014.103. Epub 2014 May 29.
OBJECTIVE
To identify risk factors for severe (third/fourth degree) perineal laceration with operative vaginal delivery (OVD, forceps or vacuum).
STUDY DESIGN
Case-control study comparing singleton OVDs with or without severe laceration (n=138).
RESULT
In multivariable analyses, severe perineal laceration was associated with occiput posterior (OP) position at delivery, vaginal nulliparity, use of forceps, longer period pushing in the second stage and lower gestational age, but not birth weight, labor induction or episiotomy. Among 29 OP patients at full dilation, 9/13 (69%) attempted rotations to occiput anterior (OA) were successful, and 14/16 (88%) patients in whom rotation was not attempted remained OP at delivery. Successful rotation from OP to OA was associated with fewer severe lacerations than no attempt or unsuccessful rotation (22 vs 75%, P=0.01).
CONCLUSION
Severe perineal laceration during OVD is associated with OP position at delivery and is reduced threefold in patients successfully rotated from OP to OA.
目的
确定经阴道手术分娩（OVD，产钳或真空吸引）导致严重（三度/四度）会阴裂伤的危险因素。
研究设计
病例对照研究，比较有或无严重裂伤的单胎经阴道手术分娩（n = 138）。
结果
在多变量分析中，严重会阴裂伤与分娩时枕后位（OP）、初产妇、使用产钳、第二产程较长的用力时间和较低的孕周有关，但与出生体重、引产或会阴切开术无关。在29例宫口全开的枕后位患者中，13例尝试转至枕前位（OA）的患者中有9例（69%）成功，16例未尝试转胎位的患者中有14例（88%）分娩时仍为枕后位。从枕后位成功转为枕前位与严重裂伤少于未尝试或转胎位不成功的情况相关（22% 对75%，P = 0.01）。
结论
经阴道手术分娩时严重会阴裂伤与分娩时枕后位有关，从枕后位成功转为枕前位的患者严重会阴裂伤减少了两倍。
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