Department of Obstetrics and Gynaecology, Trinity College, The University of Dublin, Dublin, Ireland.
Best Pract Res Clin Obstet Gynaecol. 2019 Apr;56:81-92. doi: 10.1016/j.bpobgyn.2019.01.013. Epub 2019 Feb 10.
Operative vaginal delivery (OVD) is associated with injury to the pelvic floor and compromise to the urinary, genital and gastrointestinal systems. There has been significant evolution in recent years in the practice of OVD (from the use of forceps to vacuum delivery), the conduct of delivery (from routine to selective episiotomy) and the recognition and management of obstetric anal sphincter injury (OASIS). This review article considers a number of key questions from the perspective of the clinical practitioner: What effects does OVD have on the pelvic floor? How can the effects of OVD on the pelvic floor be reduced? When and how should episiotomy be performed during OVD? How should future pregnancies following OVD and OASIS be managed? The place of episiotomy during OVD, a much debated strategy to prevent injury to the obstetric anal sphincter during OVD, is considered.
阴道分娩（operative vaginal delivery，OVD）可导致盆底损伤，并影响泌尿系统、生殖系统和胃肠道系统。近年来，OVD 的实践（从使用产钳到使用真空吸引器）、分娩方式（从常规到选择性会阴切开术）以及对产科肛门括约肌损伤（obstetric anal sphincter injury，OASIS）的认识和管理均发生了显著变化。本文从临床医生的角度考虑了一些关键问题：OVD 对盆底有哪些影响？如何减少 OVD 对盆底的影响？OVD 时应何时以及如何进行会阴切开术？OVD 和 OASIS 后如何管理后续妊娠？本文还考虑了 OVD 时会阴切开术的位置，这是一种在 OVD 期间预防产科肛门括约肌损伤的争议策略。
