Department of Obstetrics and Gynaecology, Croydon University Hospital, London, United Kingdom.
Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic.
Eur J Obstet Gynecol Reprod Biol. 2019 Sep;240:192-196. doi: 10.1016/j.ejogrb.2019.07.005. Epub 2019 Jul 9.
The role of episiotomy with regard to prevention of anal sphincter injuries (OASIS) is under discussion. The recently published guideline of the WHO "Intrapartum care for a positive childbirth experience" states that the role of episiotomy during operative vaginal deliveries remains to be established. This guideline is based on the evidence coming from randomised clinical trials. However, since the turn of the century large observational studies have pointed out that adequately performed mediolateral episiotomies may play an important role in the prevention of OASIS during operative vaginal deliveries. In this paper we present this evidence and plead for a broader vision on, and use of other evidence than randomised clinical trials solely, the preventive role of mediolateral episiotomy with regard to the occurrence of OASIS.
会阴切开术在预防肛门括约肌损伤（OASIS）方面的作用仍存在争议。世界卫生组织最近发布的《分娩期照护：积极的分娩体验指南》指出，会阴切开术在阴道助产分娩中的作用仍有待确定。该指南基于随机临床试验的证据。然而，自本世纪初以来，大量观察性研究指出，在阴道助产分娩中，正确施行的会阴正中切开术可能在预防 OASIS 方面发挥重要作用。本文介绍了这方面的证据，并呼吁人们更全面地看待会阴正中切开术在预防 OASIS 方面的作用，而不仅仅是基于随机临床试验的证据。
