Moya-Jiménez Luis C, Sánchez-Ferrer María L, Adoamnei Evdochia, Mendiola Jaime
Department of Obstetrics and Gynecology, University General Hospital Santa Lucía, Cartagena, Murcia, Spain.
Department of Obstetrics and Gynecology, "Virgen de la Arrixaca" University Clinical Hospital and Institute for Biomedical Research of Murcia, IMIB-Arrixaca, 30120, El Palmar, Murcia, Spain.
Int Urogynecol J. 2019 May;30(5):815-821. doi: 10.1007/s00192-018-3745-9. Epub 2018 Aug 23.
Episiotomy is performed selectively during vaginal delivery. Among the maternal anthropometric factors for episiotomy, the length of the perineal body (pb) and genital hiatus (gh) defined as per the POP-Q system have been studied. The objective of our study was to compare two perineal measurements (defined as per the POP-Q system and the anogenital distance [AGD] concept) to determine which of these can predict the likelihood of an episiotomy being performed.
An observational prospective cohort study was designed. Anthropometric data (pb, gh, symphysis-coccyx distance, distance between ischial tuberosities, AGDaf [anus-fourchette], and AGDac [anus-clitoris]), duration of the second stage of labor, and neonatal biometric data were collected from 119 women included in this study. Statistical analysis was performed using Student's t test for unpaired data, Mann-Whitney, and Chi-squared tests. Receiver operating characteristic (ROC) curves were generated to compare AGDaf, AGDac, and "gh + pb" with the presence of episiotomy.
A shorter "gh + pb" length and AGDac were risk factors for episiotomy. Compared with AGDac, gh + pb was a slightly better predictor in ROC curve analysis. Furthermore, a longer duration of second-stage labor was evident in the episiotomy group.
This study introduces measures of AGD as risk factors for episiotomy. We propose that "gh + pb" length <77 mm and AGDac <93 mm may predict the likelihood of requiring episiotomy and may be useful for diminishing subjectivity in the decision to perform an episiotomy.
会阴切开术在阴道分娩时选择性实施。在会阴切开术的产妇人体测量因素中，已对根据盆腔器官脱垂定量分期（POP-Q）系统定义的会阴体（pb）长度和生殖裂孔（gh）进行了研究。我们研究的目的是比较两种会阴测量方法（根据POP-Q系统定义的方法和肛门生殖距离[AGD]概念），以确定哪一种能够预测实施会阴切开术的可能性。
设计了一项观察性前瞻性队列研究。收集了本研究纳入的119名女性的人体测量数据（pb、gh、耻骨联合-尾骨距离、坐骨结节间距离、AGDaf[肛门-阴唇后联合]和AGDac[肛门-阴蒂]）、第二产程持续时间以及新生儿生物测量数据。使用非配对数据的学生t检验、曼-惠特尼检验和卡方检验进行统计分析。生成受试者工作特征（ROC）曲线，以比较AGDaf、AGDac和“gh + pb”与会阴切开术的存在情况。
“gh + pb”长度较短和AGDac是会阴切开术的危险因素。在ROC曲线分析中，与AGDac相比，gh + pb是一个稍好的预测指标。此外，会阴切开术组的第二产程持续时间明显更长。
本研究引入了AGD测量值作为会阴切开术的危险因素。我们提出，“gh + pb”长度<77 mm和AGDac<93 mm可能预测需要进行会阴切开术的可能性，并且可能有助于减少会阴切开术决策中的主观性。
