Department of Obstetrics and Gynecology, Valme University Hospital, Seville, Spain.
Department of Obstetrics and Gynecology, University of Seville, Seville, Spain.
Acta Obstet Gynecol Scand. 2019 Nov;98(11):1413-1419. doi: 10.1111/aogs.13682. Epub 2019 Jul 23.
Forceps use is the main risk factor for levator ani muscle (LAM) injuries. We believe that the disengagement of the forceps branches before delivery of the fetal head could influence LAM injuries, so we aimed to determine the influence of the disengagement of the forceps on the occurrence of LAM avulsion during forceps delivery.
A prospective, observational, multicenter study was conducted with 261 women who underwent forceps delivery. The women were classified according to whether the branches of the forceps had been disengaged before delivery of the fetal head. LAM avulsion was defined using a multislice mode (3 central slices).
In all, 255 women completed the study (160 without disengagement and 95 with disengagement). LAM avulsions were observed in 37.9% of women in the group with disengagement and in 41.9% of women in the group without disengagement. The crude OR (without disengagement vs with disengagement) for avulsion was 0.90 (95% CI 0.49-1.67, P = 0.757) and an adjusted OR of 0.82 (95% CI 0.40-1.69, P = 0.603).
We did not observe a statistically significant reduction in the LAM avulsion rate with disengagement of the forceps branches before delivery of the fetal head.
产钳使用是肛提肌（LAM）损伤的主要危险因素。我们认为，在胎头娩出前分离产钳的分支可能会影响 LAM 损伤，因此我们旨在确定在产钳分娩过程中分离产钳对 LAM 撕脱的影响。
进行了一项前瞻性、观察性、多中心研究，共纳入 261 名接受产钳分娩的女性。根据胎头娩出前产钳分支是否分离，将女性进行分类。使用多层模式（3 个中央切片）定义 LAM 撕脱。
共有 255 名女性完成了研究（无分离组 160 名，分离组 95 名）。分离组中 LAM 撕脱的发生率为 37.9%，无分离组中 LAM 撕脱的发生率为 41.9%。无分离组与分离组相比，撕脱的粗 OR（无分离 vs 分离）为 0.90（95%CI 0.49-1.67，P=0.757），调整后的 OR 为 0.82（95%CI 0.40-1.69，P=0.603）。
我们没有观察到在胎头娩出前分离产钳分支与 LAM 撕脱率降低之间存在统计学意义。
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