From the Department of Family and Community Medicine, University of Missouri-Kansas City, Kansas City, MO.
J Am Board Fam Med. 2018 Sep-Oct;31(5):768-773. doi: 10.3122/jabfm.2018.05.170400.
Studies have shown increased incidence of severe vaginal lacerations (third and fourth degree) in women under the influence of epidural analgesia. This increase has been attributed to the increased the use of operative vaginal delivery (OVD), with attendant increased risk of laceration. Although mild and moderate vaginal lacerations requiring suturing are clinically significant, their relationship to epidural analgesia has not been extensively studied.
The purpose of this study is to examine relationships between epidural analgesia in laboring women and vaginal lacerations at delivery. Our research addresses the question: "Is epidural analgesia in labor associated with reduced likelihood of vaginal laceration at delivery, compared with delivery without epidural analgesia? In addition, is there a difference in vaginal laceration rates between an urban hospital staffed by obstetricians and a suburban hospital staffed mainly by family physicians?"
For the purposes of our study we included mild and severe perineal lacerations (first through fourth degree). We included all-term singleton vaginal deliveries at Truman Medical Centers Hospital Hill and Lakewood during 2013. We conducted a retrospective chart review that included 2131 women. We examined the relationship of OVD to epidural and to laceration. Since the 2 hospitals had different characteristics, we also examined the relationship of location of delivery to laceration. We controlled for maternal age, birth weight, location of delivery, OVD, parity, and race. We examined these factors using a logistic regression analysis.
After controlling for all factors mentioned above, epidural was negatively associated with laceration (odd ratio [OR], 0.886; 95% CL, 0.665, 0.991). Other factors negatively associated with laceration included black race, parity, and delivery at Truman Medical Center Lakewood (TMCLW).
Patients who received epidural analgesia experienced fewer vaginal lacerations. There was no increase in OVD in patients who received epidural analgesia. Patients who delivered at a suburban hospital staffed by family medicine residents experienced fewer lacerations than those delivering at an urban hospital staffed by Obstetrics and Gynecology residents after controlling for race and other factors.
研究表明，硬膜外镇痛会增加严重阴道撕裂（三度和四度）的发生率。这种增加归因于产道助产（operative vaginal delivery，OVD）的使用增加，随之而来的撕裂风险增加。虽然需要缝合的轻度和中度阴道撕裂在临床上具有重要意义，但它们与硬膜外镇痛的关系尚未得到广泛研究。
本研究旨在检查分娩妇女硬膜外镇痛与分娩时阴道撕裂的关系。我们的研究旨在回答以下问题：“与无硬膜外镇痛分娩相比，分娩时使用硬膜外镇痛是否会降低分娩时阴道撕裂的可能性？此外，在由妇产科医生和主要由家庭医生组成的城市医院和郊区医院之间，阴道撕裂发生率是否存在差异？”
为了进行我们的研究，我们纳入了轻度和重度会阴撕裂（一度至四度）。我们纳入了 2013 年在 Truman Medical Centers Hospital Hill 和 Lakewood 进行的所有足月单胎阴道分娩。我们进行了回顾性图表审查，包括 2131 名女性。我们检查了 OVD 与硬膜外和撕裂的关系。由于这 2 家医院具有不同的特点，我们还检查了分娩地点与撕裂的关系。我们控制了产妇年龄、出生体重、分娩地点、OVD、产次和种族。我们使用逻辑回归分析检查了这些因素。
在控制了上述所有因素后，硬膜外与撕裂呈负相关（比值比 [OR]，0.886；95%置信区间 [CI]，0.665，0.991）。与撕裂呈负相关的其他因素包括黑人种族、产次和在 Truman Medical Center Lakewood（TMCLW）分娩。
接受硬膜外镇痛的患者阴道撕裂的发生率较低。接受硬膜外镇痛的患者中，OVD 的使用并未增加。在控制种族和其他因素后，在由家庭医学住院医师管理的郊区医院分娩的患者比在由妇产科住院医师管理的城市医院分娩的患者撕裂发生率更低。
