Department of Obstetrics and Gynecology, Besançon University Medical Center, Besançon, France.
J Matern Fetal Neonatal Med. 2020 Oct;33(19):3308-3312. doi: 10.1080/14767058.2019.1571573. Epub 2019 Feb 3.
Our purpose was to evaluate the impact of active delivery of the anterior arm with Couder's Maneuver (CM) during vacuum-assisted vaginal delivery (VAVD) on perineal tears. This maneuver can be beneficial because it has the advantage of reducing fetal biacromial diameter. This monocentric retrospective study compared two non-concurrent cohorts of nulliparous women before and after implementation of a systematic CM during VAVD: Cohort 1 from 1 January to 31 December 2006 without CM and Cohort 2 from 1 January to 31 December 2016 with systematic CM. This study reviewed all births during these two periods. All live-born singleton pregnancies where VAVD occurred after 37 weeks of gestation were included. The principal endpoint was the type of perineal tear. In total, there were 179 VAVD in the Cohort 1 and 267 VAVD in the Cohort 2. In the Cohort 2, 233 VAVD (87.3%) were performed with systematic CM. No episiotomy was performed in both cohorts. There was a significant decrease in the rate of second-degree perineal tears between the two cohorts (42.4 versus 15%, < .001) and a significant increase in the rate of intact perineum (34.1 versus 54.7%, < .001). There was no influence of CM on the rate of obstetrical anal sphincter injury (3.9 versus 2.6%, = .44). Practicing this maneuver could improve the perineal prognosis during VAVD in nulliparous women.
我们的目的是评估在真空辅助阴道分娩（VAVD）中使用 Couder 的手法（CM）主动传递前肢对会阴撕裂的影响。这种手法可能是有益的，因为它具有减少胎儿双径的优势。这项单中心回顾性研究比较了在 VAVD 中系统实施 CM 前后的两个非同期的初产妇队列：队列 1 为 2006 年 1 月 1 日至 12 月 31 日，无 CM；队列 2 为 2016 年 1 月 1 日至 12 月 31 日，有系统 CM。这项研究回顾了这两个时期的所有分娩。所有在 37 周后发生 VAVD 的活产单胎妊娠均被纳入研究。主要终点是会阴撕裂的类型。队列 1 中有 179 例 VAVD，队列 2 中有 267 例 VAVD。在队列 2 中，233 例 VAVD（87.3%）使用系统 CM 进行。两个队列均未进行会阴切开术。两组间二度会阴撕裂的发生率显著降低（42.4%比 15%，<0.001），完整会阴的发生率显著升高（34.1%比 54.7%，<0.001）。CM 对产科肛门括约肌损伤的发生率无影响（3.9%比 2.6%，=0.44）。在初产妇的 VAVD 中实施该手法可能会改善会阴的预后。
