Ma Kenneth, Byrd Louise
Obstetric Department, St Mary's Hospital, Central Manchester Foundation Trust, Manchester, UK.
Obstetric Department, St Mary's Hospital, Central Manchester Foundation Trust, Manchester, UK.
Eur J Obstet Gynecol Reprod Biol. 2017 Jun;213:102-106. doi: 10.1016/j.ejogrb.2017.04.006. Epub 2017 Apr 11.
Although episiotomies are the commonest obstetric procedure performed the technique of performing one varies amongst obstetricians and midwives. The angle of episiotomy to the midline in particular has been shown to influence the risk of developing obstetric anal sphincter injuries (OASIS). In order to identify the differences in technique and to identify targets for training we undertook a practice survey of episiotomies to analyse the differences in technique between grades of obstetricians and midwives.
A prospective practice survey of staff working on delivery suite in a tertiary referral unit with 9000 deliveries/year was conducted between 01/10/2014 to 01/03/2015. Each participant was provided with a pictoral representation of a perineum and a pair of standard episiotomy scissors and asked to perform an episiotomy as per their usual practice. The profession and grade of each participant was recorded along with information regarding the incision including the angle to the midline, length of incision and lateral starting distance from the midline. One way ANOVA (unrelated) was used to perform statistical analysis using IBM SPSS v23.
101 staff members participated in the practice survey including 63 midwives, 9 junior trainees, 15 senior trainees and 14 consultants. The mean angle of incision to the midline of episiotomies was 47°, 51°, 66° and 77° for midwives, junior trainees, senior trainees and consultants respectively. The mean angle of incision performed by midwives was significantly different to senior trainees (p>0.01) and consultants (p<0.01). 45% of all episiotomies undertaken by midwives were done at an angle <45° to the midline, compared to 7% by senior trainees and none by consultants.
This study identified clear deficiencies in the performance of episiotomies amongst obstetric trainees and midwives. Both midwives and obstetric trainees need to improve their technique if episiotomies are going to influence the incidence of OASIS and, more importantly the development of faecal incontinence. These results should be used to inform future training programmes to reduce the risks of OASIS.
尽管会阴切开术是最常见的产科手术，但不同产科医生和助产士实施该手术的技术存在差异。尤其是会阴切开术与中线的角度已被证明会影响产科肛门括约肌损伤（OASIS）的发生风险。为了找出技术差异并确定培训目标，我们对会阴切开术进行了一项实践调查，以分析不同级别产科医生和助产士之间的技术差异。
在2014年10月1日至2015年3月1日期间，对一家每年有9000例分娩的三级转诊单位产房工作人员进行了一项前瞻性实践调查。为每位参与者提供一张会阴的图片和一把标准会阴切开剪，并要求他们按照自己的常规做法进行会阴切开术。记录每位参与者的职业和级别以及有关切口的信息，包括与中线的角度、切口长度和距中线的外侧起始距离。使用IBM SPSS v23软件，采用单因素方差分析（非相关）进行统计分析。
101名工作人员参与了实践调查，其中包括63名助产士、9名初级学员、15名高级学员和14名顾问。助产士、初级学员、高级学员和顾问进行会阴切开术时，切口与中线的平均角度分别为47°、51°、66°和77°。助产士进行的切口平均角度与高级学员（p>0.01）和顾问（p<0.01）有显著差异。助产士进行的所有会阴切开术中，45%的切口与中线的角度<45°，相比之下，高级学员为7%，顾问则无。
本研究发现产科实习生和助产士在会阴切开术操作方面存在明显不足。如果会阴切开术要影响OASIS的发生率，更重要的是要影响大便失禁的发生，助产士和产科实习生都需要改进他们的技术。这些结果应用于为未来的培训计划提供信息，以降低OASIS的风险。
