Shmueli Anat, Gabbay Benziv Rinat, Hiersch Liran, Ashwal Eran, Aviram Rami, Yogev Yariv, Aviram Amir
a Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tikva, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University , Ramat-Aviv , Israel.
b Lis Maternity Hospital, The Tel-Aviv Sourasky Medical Center, Tel Aviv, The Sackler Faculty of Medicine, Tel-Aviv University , Ramat-Aviv , Israel , and.
J Matern Fetal Neonatal Med. 2017 Feb;30(3):251-256. doi: 10.3109/14767058.2016.1169527. Epub 2016 Apr 19.
To identify risk factors for mediolateral episiotomy, and evaluate the risk of obstetrical anal sphincter injury (OASI) among women with an episiotomy.
A retrospective cohort study of all singletons vaginal deliveries at term between 2007 and 2014. Spontaneous and operative vaginal deliveries were compared separately, as well as nulliparous and multiparous women.
Overall, 41,347 women were included in the spontaneous vaginal delivery group: 12,585 (30.4%) nulliparous and 28,762 (69.6%) multiparous women. Risk factors for episiotomy (nulliparous) were maternal age (aOR 0.98), gestational age (GA, aOR 1.07), regional analgesia (RA, aOR 1.18), labor induction (aOR 1.17), meconium (aOR 1.37) and birth weight (BW, aOR 1.04). Episiotomy was associated with PPH (aOR 1.49). Among multiparous, risk factors were maternal age (aOR 1.04), previous vaginal delivery (aOR 0.38), GA (aOR 1.06), RA (aOR 1.22), meconium (aOR 1.22) and BW (aOR 1.05). Episiotomy was associated with 3rd degree perineal tear (aOR 2.26, 95% CI 1.03-4.97). Only birth weight (nulliparous) and previous vaginal deliveries (multiparous) were contributors for episiotomy in the OVD group.
Several risk factors for mediolateral episiotomy exist. Episiotomy does not protect nulliparous women, and may be associated with an increased risk for multiparous, for OASI. Therefore, the practice of routine episiotomy should be abandoned, and the practice of selective episiotomy reconsidered.
确定会阴侧切术的危险因素，并评估行会阴侧切术的女性发生产科肛门括约肌损伤（OASI）的风险。
对2007年至2014年期间所有足月单胎阴道分娩进行回顾性队列研究。分别比较了自然阴道分娩和手术阴道分娩，以及初产妇和经产妇。
总体而言，自然阴道分娩组纳入了41347名女性：12585名（30.4%）初产妇和28762名（69.6%）经产妇。会阴侧切术（初产妇）的危险因素包括产妇年龄（调整后比值比[aOR]0.98）、孕周（GA，aOR 1.07）、区域镇痛（RA，aOR 1.18）、引产（aOR 1.17）、胎粪（aOR 1.37）和出生体重（BW，aOR 1.04）。会阴侧切术与产后出血（PPH）相关（aOR 1.49）。在经产妇中，危险因素包括产妇年龄（aOR 1.04）、既往阴道分娩史（aOR 0.38）、GA（aOR 1.06）、RA（aOR 1.22）、胎粪（aOR 1.22）和BW（aOR 1.05）。会阴侧切术与三度会阴裂伤相关（aOR 2.26，95%置信区间[CI]1.03 - 4.97）。在手术阴道分娩组中，只有出生体重（初产妇）和既往阴道分娩史（经产妇）是会阴侧切术的影响因素。
存在几种会阴侧切术的危险因素。会阴侧切术对初产妇没有保护作用，且可能会增加经产妇发生OASI的风险。因此，应摒弃常规会阴侧切术的做法，并重新考虑选择性会阴侧切术的做法。
