Fritel X, Gachon B, Desseauve D, Thubert T
Service de gynécologie-obstétrique et médecine de la reproduction, Inserm CIC1402, université de Poitiers, CHU de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France.
Service de gynécologie-obstétrique et médecine de la reproduction, université de Poitiers, CHU de Poitiers, 86000 Poitiers, France.
Gynecol Obstet Fertil Senol. 2018 Apr;46(4):419-426. doi: 10.1016/j.gofs.2018.01.004. Epub 2018 Feb 28.
Our main objectives were to identify risk factors, methods for early diagnosis, and prevention of obstetric anal sphincter injuries (OASIs), using a literature review. The main risk factors for OASIs are nulliparity, instrumental delivery, posterior presentation, median episiotomy, prolonged second phase of labor and fetal macrosomia. Asian origin, short ano-vulvar distance, ligamentous hyperlaxity, lack of expulsion control, non-visualization of the perineum or maneuvers for shoulder dystocia also appear to be risk factors. There is a risk of under-diagnosis of OASIs in the labor ward. Experience of the accoucheur is a protective factor. Secondary prevention is based on the training of birth professionals in recognition and repair of OASIs. Primary prevention of OASIs is based on training in the maneuvers of the second phase of labor; if possible, instrumental extractions should be avoided. Mediolateral episiotomy may have a preventive role in high-risk OASIs deliveries. A robust predictive model is still lacking to allow a selective use of episiotomy.
我们的主要目标是通过文献综述，确定产科肛门括约肌损伤（OASIs）的风险因素、早期诊断方法及预防措施。OASIs的主要风险因素包括初产、器械助产、胎位后位、正中会阴切开术、第二产程延长和巨大儿。亚洲裔、肛门至外阴距离短、韧带松弛、缺乏娩出控制、会阴不可见或处理肩难产的手法也似乎是风险因素。在产房存在OASIs诊断不足的风险。接生人员的经验是一个保护因素。二级预防基于对分娩专业人员进行OASIs识别和修复方面的培训。OASIs的一级预防基于第二产程手法的培训；若可能，应避免器械助产。会阴侧切术可能在高风险OASIs分娩中起到预防作用。目前仍缺乏一个强大的预测模型来指导选择性使用会阴切开术。
