Trinh Anh T, Roberts Christine L, Ampt Amanda J
Hung Vuong Hospital, 128 Hong Bang Street, Ward 5, Ho Chi Minh City, Vietnam.
Clinical and Population Perinatal Health Research, Kolling Institute, The University of Sydney at Royal North Shore Hospital, Building 52, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia.
BMC Pregnancy Childbirth. 2015 Apr 23;15:101. doi: 10.1186/s12884-015-0531-2.
Episiotomy remains a routine procedure at childbirth in many South-East Asian countries but the reasons for this are unknown. The aim of this study was to determine the knowledge of, attitudes towards and experience of episiotomy use among clinicians in Viet Nam.
All obstetricians and midwives who provide delivery care at Hung Vuong Hospital were surveyed about their practice, knowledge and attitudes towards episiotomy use. Data were analysed using frequency tabulations and contingency table analysis.
148 (88%) clinicians completed the questionnaire. Fewer obstetricians (52.2%) than midwives (79.7%) thought the current episiotomy rate of 86% was about right (P < 0.01). Most obstetricians (82.6%) and midwives (98.7%) reported performing episiotomies on nulliparous women over 90% of the time. Among multipara, 24.6% of obstetricians reported performing episiotomy less than 60% of the time compared with only 3 (3.8%) midwives (P < 0.01). Aiming to reduce 3rd-4th degree perineal tears was the most commonly reported reason for performing an episiotomy by both obstetricians (76.8%) and midwives (82.3%), and lack of training in how to minimize tears and keep the perineum intact was the mostly commonly reported obstacle (obstetricians 56.5%, midwives 36.7% P = 0.02) to reducing the episiotomy rate.
Although several factors that may impede or facilitate episiotomy practice change were identified by our survey, training and confidence in normal vaginal birth without episiotomy is a priority.
在许多东南亚国家，会阴切开术仍是分娩时的常规操作，但原因不明。本研究的目的是确定越南临床医生对会阴切开术的了解、态度及使用经验。
对在洪王医院提供分娩护理的所有产科医生和助产士进行了关于他们对会阴切开术的操作、知识和态度的调查。使用频率表和列联表分析数据。
148名（88%）临床医生完成了问卷。认为当前86%的会阴切开率合适的产科医生（52.2%）少于助产士（79.7%）（P<0.01）。大多数产科医生（82.6%）和助产士（98.7%）报告在超过90%的时间里对初产妇进行会阴切开术。在经产妇中，24.6%的产科医生报告会阴切开术的实施时间少于60%，而助产士只有3名（3.8%）（P<0.01）。产科医生（76.8%）和助产士（82.3%）最常报告的进行会阴切开术的原因是旨在减少三度至四度会阴撕裂，而缺乏如何尽量减少撕裂和保持会阴完整的培训是降低会阴切开率最常报告的障碍（产科医生56.5%，助产士36.7%，P=0.02）。
尽管我们的调查确定了一些可能阻碍或促进会阴切开术实践改变的因素，但对无会阴切开术的正常阴道分娩进行培训并增强信心是当务之急。
