Drusany Staric Kristina, Lukanovic Adolf, Petrocnik Petra, Zacesta Vita, Cescon Corrado, Lucovnik Miha
Division of Obstetrics and Gynaecology, University Medical Centre Ljubljana, Slajmerjeva 4, 1000 Ljubljana, Slovenia.
Faculty of Health Sciences, Midwifery Division, University of Ljubljana, Zdravstvena pot 5, 1000 Ljubljana, Slovenia.
Midwifery. 2017 Aug;51:40-43. doi: 10.1016/j.midw.2017.05.008. Epub 2017 May 18.
to examine potential association between mediolateral episiotomy and reduced incidence of obstetrical anal sphincter injuries (OASIS) diagnosed by endoanal ultrasound.
prospective cohort study.
tertiary referral university hospital.
sixty nulliparous women at 28-33 weeks of gestation with singleton pregnancies were included between 2010 and 2012.
participants were examined with endoanal ultrasound at 28-33 weeks gestation and at 6-7 weeks post-partum. At both visits, symptoms of anal incontinence were assessed using Cleveland Clinic (Wexner) faecal incontinence scoring system. Mann Whitney U-test and χ test was used to compare groups with vs. without episiotomy and groups with vs. without OASIS diagnosed by ultrasound. χ test was used to assess correlation between OASIS and anal incontinence symptoms (p≤0.05 considered significant). None of the women included had sphincter injury or anal incontinence before childbirth. All delivered vaginally. Mediolateral episiotomy was performed in 33 (55%) cases. Six (10%) had OASIS on endoanal ultrasound (two were also diagnosed clinically), and 11 had symptoms of anal incontinence post-partum. No significant differences were seen in clinical characteristics between groups with vs. without episiotomy. No significant differences were seen in episiotomy rate (p=0.14), angle (p=0.42) and length (p=0.14) between groups with vs. without OASIS on ultrasound. Correlation between anal incontinence symptoms and sonographically diagnosed OASIS was statistically significant (p=0.04).
mediolateral episiotomy does not seem to be protective against clinically or sonographically diagnosed OASIS even when episiotomy technique is considered. Endoanal ultrasound allows a significantly better detection of symptomatic OASIS compared to clinical examination alone.
mediolateral episiotomy should be considered only when shortening the second stage of labour is indicated due to foetal distress, and not as a means of OASIS prevention.
探讨会阴侧切术与经肛门内超声诊断的产科肛门括约肌损伤（OASIS）发生率降低之间的潜在关联。
前瞻性队列研究。
三级转诊大学医院。
2010年至2012年期间纳入了60名单胎妊娠、妊娠28 - 33周的初产妇。
在妊娠28 - 33周以及产后6 - 7周对参与者进行经肛门内超声检查。在两次检查时，使用克利夫兰诊所（韦克斯纳）大便失禁评分系统评估肛门失禁症状。采用曼-惠特尼U检验和χ检验比较有会阴侧切术与无会阴侧切术的组以及经超声诊断有OASIS与无OASIS的组。采用χ检验评估OASIS与肛门失禁症状之间的相关性（p≤0.05认为具有显著性）。纳入的所有女性在分娩前均无括约肌损伤或肛门失禁。所有产妇均经阴道分娩。33例（55%）进行了会阴侧切术。6例（10%）经肛门内超声检查诊断为OASIS（其中2例临床也诊断为OASIS），11例产后有肛门失禁症状。有会阴侧切术与无会阴侧切术的组之间临床特征无显著差异。超声检查有OASIS与无OASIS的组之间，会阴侧切率（p = 0.14）、角度（p = 0.42）和长度（p = 0.14）无显著差异。肛门失禁症状与超声诊断的OASIS之间的相关性具有统计学意义（p = 0.04）。
即使考虑会阴侧切术技术，会阴侧切术似乎也不能预防临床或超声诊断的OASIS。与单纯临床检查相比，经肛门内超声能显著更好地检测出有症状的OASIS。
仅在因胎儿窘迫需要缩短第二产程时才应考虑会阴侧切术，而不应将其作为预防OASIS的手段。
