Escuriet Ramón, Pueyo María J, Perez-Botella Mercedes, Espada Xavi, Salgado Isabel, Gómez Analía, Biescas Herminia, Espiga Isabel, White Joanna, Fernandez Rosa, Fusté Josep, Ortún Vicente
Directorate-General for Health Planning and Research, Ministry of Health of the Government of Catalonia, Barcelona, Spain.
Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain.
BMC Health Serv Res. 2015 Mar 11;15:95. doi: 10.1186/s12913-015-0753-z.
In Spain, the Strategy for Assistance in Normal Childbirth (SANC) promoted a model of care, which respects the physiological birth process and discards unnecessary routine interventions, such as episiotomies. We evaluated the rate of episiotomy use and perineal trauma as indicators of how selective introduction of the SANC initiative has impacted childbirth outcomes in hospitals of Catalonia.
Cross-sectional study of all singleton vaginal term deliveries without instrument registered in the Minimum Basic Data Set (MBDS) of Catalonia in 2007, 2010 and 2012. Hospitals were divided into types according to funding (public or private), and four strata were differentiated according to volume of births attended. Episiotomies and perineal injury were considered dependent variables. The relationship between qualitative variables was analysed using the chi-squared test, and Student's t-test was used for quantitative variables. Comparison of proportions was performed on the two hospital groups between 2007 and 2012 using a Z-test. Logistic regression models were used to analyse the relationship between episiotomy or severe perineal damage and maternal age, volume of births and hospital type, obtaining odds ratios (OR) and 95% confidence intervals (CI).
The majority of normal singleton term deliveries were attended in public hospitals, where maternal age was lower than for women attended in private hospitals. Analysis revealed a statistically significant (P < 0.001) decreasing trend in episiotomy use in Catalonia for both hospital types. Private hospitals appeared to be associated with increased episiotomy rate in 2007 (OR = 1.099, CI: 1,057-1,142), 2010 (OR = 1.528, CI: 1,472-1,587) and 2012 (OR = 1.459, CI: 1,383-1,540), and a lower rate of severe perineal trauma in 2007 (OR = 0.164, CI: 0.095-0.283), 2010 (OR = 0.16, CI: 0.110-0.232) and 2012 (OR = 0.19, CI: 0.107-0.336). Regarding severe perineal injury, when independent variables were adjusted, maternal age ceased to have a significant correlation in 2012 (OR = 0.994, CI: 0.970-1.018).
Episiotomy procedures during normal singleton vaginal term deliveries in Catalonia has decreased steadily since 2007. Study results show a stable incidence trend below 1% for severe perineal trauma over the study period.
在西班牙，正常分娩援助策略（SANC）推广了一种护理模式，该模式尊重自然分娩过程，摒弃了诸如会阴切开术等不必要的常规干预措施。我们评估了会阴切开术的使用比例和会阴创伤情况，以此作为SANC倡议的选择性引入对加泰罗尼亚医院分娩结局影响的指标。
对2007年、2010年和2012年在加泰罗尼亚最低基本数据集（MBDS）中登记的所有无器械辅助的单胎足月阴道分娩进行横断面研究。医院根据资金来源（公立或私立）进行分类，并根据分娩量分为四个层次。会阴切开术和会阴损伤被视为因变量。使用卡方检验分析定性变量之间的关系，定量变量则使用学生t检验。采用Z检验对2007年至2012年两组医院之间的比例进行比较。使用逻辑回归模型分析会阴切开术或严重会阴损伤与产妇年龄、分娩量和医院类型之间的关系，得出比值比（OR）和95%置信区间（CI）。
大多数正常单胎足月分娩在公立医院进行，公立医院产妇的年龄低于私立医院。分析显示，加泰罗尼亚两种类型医院的会阴切开术使用比例均呈具有统计学意义（P < 0.001）的下降趋势。私立医院在2007年（OR = 1.099，CI：1,057 - 1,142）、2010年（OR = 1.528，CI：1,472 - 1,587）和2012年（OR = 1.459，CI：1,383 - 1,540）的会阴切开术比例似乎较高，而在2007年（OR = 0.164，CI：0.095 - 0.283）、2010年（OR = 0.16，CI：0.110 - 0.232）和2012年（OR = 0.19，CI：0.107 - 0.336）严重会阴创伤比例较低。关于严重会阴损伤，在调整自变量后，产妇年龄在2012年不再具有显著相关性（OR = 0.994，CI：0.970 - 1.018）。
自2007年以来，加泰罗尼亚正常单胎足月阴道分娩时的会阴切开术程序稳步减少。研究结果表明，在研究期间严重会阴创伤的发生率稳定在1%以下。
