Mizrachi Yossi, Leytes Sophia, Levy Michal, Hiaev Zvia, Ginath Shimon, Bar Jacob, Kovo Michal
Department of Obstetrics & Gynecology, Edith Wolfson Medical Center, Holon, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Birth. 2017 Jun;44(2):161-166. doi: 10.1111/birt.12278. Epub 2017 Feb 15.
Our aim was to study whether midwife experience affects the rate of severe perineal tears (3rd and 4th degree).
A retrospective cohort study of all women with term vertex singleton pregnancies, who underwent normal vaginal deliveries, in a single tertiary hospital, between 2011 and 2015, was performed. Exclusion criteria were instrumental deliveries and stillbirth. All midwives used a "hands on" technique for protecting the perineum. The midwife experience at each delivery was calculated as the time interval between her first delivery and current delivery. A comparison was performed between deliveries in which midwife experience was less than 2 years (inexperienced), between 2 and 10 years (moderately experienced), and more than 10 years (highly experienced). A multivariate regression analysis was performed to assess the association between midwife experience and the incidence of severe perineal tears, after controlling for confounders.
Overall, 15 146 deliveries were included. Severe perineal tears were diagnosed in 51 (0.33%) deliveries. Women delivered by inexperienced midwives had a higher rate of severe perineal tears compared with women delivered by highly experienced midwives (0.5% vs 0.2%, respectively, P=.024). On multivariate regression analysis, midwife experience was independently associated with a lower rate of severe perineal tears, after controlling for confounding factors. Each additional year of experience was associated with a 4.7% decrease in the risk of severe perineal tears (adjusted OR 0.95 [95% CI 0.91-0.99, P=.03).
More experienced midwives had a lower rate of severe perineal tears, and may be preferred for managing deliveries of women at high risk for such tears.
我们的目的是研究助产士经验是否会影响严重会阴撕裂（三度和四度）的发生率。
对2011年至2015年期间在一家三级医院进行正常阴道分娩的所有足月单胎头位妊娠妇女进行回顾性队列研究。排除标准为器械助产和死产。所有助产士均采用“手把手”技术保护会阴。每次分娩时助产士的经验通过其首次分娩与当前分娩之间的时间间隔来计算。对助产士经验少于2年（经验不足）、2至10年（经验中等）和超过10年（经验丰富）的分娩情况进行比较。在控制混杂因素后，进行多变量回归分析以评估助产士经验与严重会阴撕裂发生率之间的关联。
总体纳入15146例分娩。51例（0.33%）分娩被诊断为严重会阴撕裂。与由经验丰富的助产士接生的妇女相比，由经验不足的助产士接生的妇女严重会阴撕裂发生率更高（分别为0.5%和0.2%，P = 0.024）。在多变量回归分析中，控制混杂因素后，助产士经验与较低的严重会阴撕裂发生率独立相关。每增加一年经验，严重会阴撕裂风险降低4.7%（校正比值比0.95 [95%可信区间0.91 - 0.99，P = 0.03]）。
经验更丰富的助产士严重会阴撕裂发生率较低，对于有此类撕裂高风险的妇女分娩管理可能更受青睐。
