Zimmo Kaled Mikki, Laine Katariina, Fosse Erik, Zimmo Mohammed, Ali-Masri Hadil, Böttcher Bettina, Zucknick Manuela, Vikanes Åse, Hassan Sahar
Department of Obstetrics, Al Aqsa Hospital, Gaza, Palestine.
The Intervention Centre, Oslo University Hospital, Rikshospitalet, 4950 Nydalen, 0424, Oslo, Norway.
Int Urogynecol J. 2019 Aug;30(8):1343-1350. doi: 10.1007/s00192-018-3711-6. Epub 2018 Jul 14.
In Palestine, episiotomy is frequently used among primiparous women.This study assesses the effect of training birth attendants in applying bimanual perineal support during delivery by either animated instruction on tablets or hands-on training on episiotomy rates among primiparous women.
An interventional cohort study was performed from 15 October 2015 to 31 January 2017, including all primiparous women with singletons and noninstrumental vaginal deliveries at six Palestinian hospitals. Intervention 1 (animated instructions on tablets) was conducted in Hospitals 1, 2, 3, and 4. Intervention 2 (bedside hands-on training) was applied in Hospitals 1 and 2 only. Hospitals 5 and 6 did not receive interventions. Differences in episiotomy rates in intervention and nonintervention hospitals were assessed before and after the interventions and presented as p values using chi-square test, and odds ratios (OR) with 95% confidence intervals (CI). Differences in the demographic and obstetric characteristics were presented as p values using the Kruskal-Wallis test.
Of 46,709 women, 12,841 were included. The overall episiotomy rate in the intervention hospitals did not change significantly after intervention 1, from 63.1 to 62.1% (OR = 0.96, 95% CI 0.84-1.08), but did so after intervention 2, from 61.1 to 38.1% (OR = 0.39, 95% CI 0.33-0.47). Rates after Intervention 2 changed from 65.0 to 47.3% (OR = 0.52, 95% CI 0.40-0.67) in Hospital 1 and from 39.4 to 25.1% (OR = 0.49, 95% CI 0.35-0.68) in Hospital 2.
Hands-on training of bimanual perineal support during delivery of primiparous women was significantly more effective in reducing episiotomy rates than animated instruction videos alone.
在巴勒斯坦，初产妇中会阴切开术的使用非常频繁。本研究评估了通过平板电脑上的动画教学或实际操作培训对助产人员进行分娩时双手会阴支撑应用培训，对初产妇会阴切开率的影响。
2015年10月15日至2017年1月31日进行了一项干预性队列研究，纳入了巴勒斯坦六家医院所有单胎且非器械助产阴道分娩的初产妇。干预1（平板电脑上的动画教学）在第1、2、3和4医院进行。干预2（床边实际操作培训）仅在第1和2医院实施。第5和6医院未接受干预。在干预前后评估干预医院和非干预医院会阴切开率的差异，并使用卡方检验以p值呈现，以及给出95%置信区间（CI）的比值比（OR）。人口统计学和产科特征的差异使用Kruskal-Wallis检验以p值呈现。
在46709名女性中，12841名被纳入研究。干预1后，干预医院的总体会阴切开率从63.1%降至62.1%，无显著变化（OR = 0.96，95% CI 0.84 - 1.08），但干预2后有显著变化，从61.1%降至38.1%（OR = 0.39，95% CI 0.33 - 0.47）。干预2后，第1医院的会阴切开率从65.0%降至47.3%（OR = 0.52，95% CI 0.40 - 0.67），第2医院从39.4%降至25.1%（OR = 0.49，95% CI 0.35 - 0.68）。
对初产妇分娩时双手会阴支撑进行实际操作培训在降低会阴切开率方面比单纯的动画教学视频显著更有效。
