Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Brigham and Women's Hospital, Boston, MA, USA.
J Perinatol. 2018 Dec;38(12):1625-1630. doi: 10.1038/s41372-018-0252-2. Epub 2018 Oct 18.
Identify risk factors for poor perineal outcome after operative vaginal delivery.
A retrospective cohort study was performed including operative vaginal deliveries during 2015 through 2016.
Of 529 operative vaginal deliveries, 79 (14.9%) had higher order perineal lacerations and 14 (2.7%) had a wound breakdown. The only significant risk factor for higher order lacerations was chorioamnionitis (aOR 2.2; 95% CI 1.09-4.44). Risk factors for perineal wound breakdown included episiotomy (5.2 vs. 1.2%; p < 0.01), type of operative delivery (5.5% after forceps vs. 1.4% after vacuum; p < 0.01) and postpartum narcotic use. Overall, 9.3% of those using narcotics subsequently had a perineal breakdown as compared to 0.7% (p < 0.01). Narcotic use postpartum remained strongly associated in multivariable logistic regression (aOR 21.29; 95% CI 5.43-83.47). Patients with forceps deliveries, episiotomy, and narcotic use had a 38% risk of breakdown.
Women at highest risk of perineal wound breakdown benefit from close follow-up.
确定经阴道分娩会阴不良结局的危险因素。
回顾性队列研究，纳入 2015 年至 2016 年经阴道分娩病例。
在 529 例经阴道分娩中，79 例（14.9%）发生了更高程度的会阴裂伤，14 例（2.7%）发生了伤口裂开。更高程度会阴裂伤的唯一显著危险因素是绒毛膜羊膜炎（aOR 2.2；95%CI 1.09-4.44）。会阴伤口裂开的危险因素包括会阴切开术（5.2% vs. 1.2%；p<0.01）、分娩方式（产钳分娩 5.5% vs. 真空分娩 1.4%；p<0.01）和产后使用阿片类药物。总体而言，9.3%使用阿片类药物的患者随后发生会阴裂开，而 0.7%未使用阿片类药物的患者发生会阴裂开（p<0.01）。多变量逻辑回归显示，产后使用阿片类药物与会阴裂开仍密切相关（aOR 21.29；95%CI 5.43-83.47）。接受产钳分娩、会阴切开术和使用阿片类药物的患者，会阴裂开的风险增加 38%。
会阴伤口裂开风险最高的女性需要密切随访。
