Department of Obstetrics and Gynecology, La Miletrie University Hospital, 2 rue de la Milétrie CS90577, 86021, Poitiers Cedex, France.
INSERM, Center for Research in Epidemiology and Population Health (CESP), U1018, Gender, Sexuality and Health Team, Univ Paris-Sud, UMRS 1018, Orsay, France.
Arch Gynecol Obstet. 2019 Jul;300(1):87-94. doi: 10.1007/s00404-019-05174-0. Epub 2019 May 5.
Our main objective was to investigate whether the implementation of a restrictive episiotomy policy in operative deliveries changes the incidence of obstetric anal sphincter injury (OASI).
This is an observational study over an 11-year period in Poitiers University Maternity, France. We included women with vaginal operative deliveries after 34 gestational weeks for singleton births in cephalic presentation. We collected data on the mother and operative delivery characteristics: indication, instrument, epidural analgesia, labor length, episiotomy, OASI, and birthweight. We investigated the changes in the mediolateral episiotomy (MLE) and OASI rates and the association between MLE and OASI. The primary outcome was the evolution of the OASI and MLE rates. The secondary outcome was the occurrence of OASI during operative delivery with or without MLE.
In total, 2357 operative deliveries were assessed, including 847 vacuum-, 1350 forceps- and 160 spatula-assisted deliveries. Of these, 950 were performed with MLE and 1407 without; 37 OASIs (3.9%) occurred in the MLE group, and 137 (9.7%) in the no-MLE group. Between 2005 and 2015, MLE use decreased from 78.5 to 16.2% and OASI occurrence increased from 3.1 to 12.7%. The increase in OASI occurrence was significant for forceps deliveries, but not for vacuum or spatula deliveries. Operative delivery with MLE was associated with a three times lower OASI occurrence than that without MLE (adjusted OR = 0.29, 95% CI [0.20-0.43]).
Implementation of a restrictive MLE policy for operative delivery seems to be associated with an increase in OASI incidence with forceps, but not with vacuum.
我们的主要目的是研究在剖宫产中实施限制会阴切开术政策是否会改变产科肛门括约肌损伤（OASI）的发生率。
这是法国普瓦捷大学妇产医院一项为期 11 年的观察性研究。我们纳入了经阴道分娩、单胎头位分娩且妊娠 34 周以上的产妇。我们收集了母亲和剖宫产手术特征的数据：指征、器械、硬膜外镇痛、产程、会阴切开术、OASI 和出生体重。我们研究了会阴正中切开术（MLE）和 OASI 发生率的变化以及 MLE 和 OASI 之间的关系。主要结局是 OASI 和 MLE 发生率的变化。次要结局是有或没有 MLE 的剖宫产术中 OASI 的发生。
共评估了 2357 例剖宫产术，其中包括 847 例真空吸引、1350 例产钳和 160 例匙状助产。其中，950 例行 MLE，1407 例行非 MLE；MLE 组发生 37 例 OASI（3.9%），非 MLE 组发生 137 例（9.7%）。2005 年至 2015 年期间，MLE 的使用率从 78.5%降至 16.2%，OASI 的发生率从 3.1%增至 12.7%。产钳分娩的 OASI 发生率增加具有统计学意义，但真空吸引或匙状助产分娩的 OASI 发生率无明显变化。行 MLE 的剖宫产术与未行 MLE 的剖宫产术相比，OASI 的发生风险降低了三倍（校正 OR=0.29，95%CI[0.20-0.43]）。
在剖宫产中实施限制会阴切开术政策似乎与产钳分娩的 OASI 发生率增加相关，但与真空吸引无关。
