CHRU Dijon, Department of gynecology, obstetrics, fetal medicine and infertility, Dijon, France.
Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM, Paris, France, Paris Descartes University, Paris, France.
BMC Pregnancy Childbirth. 2019 Aug 16;19(1):300. doi: 10.1186/s12884-019-2424-2.
Though the rate of episiotomy has decreased in France, the overall episiotomy rate was 20% in the 2016 national perinatal survey. We aimed to develop a classification to facilitate the analysis of episiotomy practices and to evaluate whether episiotomy is associated with a reduction in the rate of obstetric anal sphincter injuries (OASIS) for each subgroup.
This population-based study included all the deliveries that occurred in the Burgundy Perinatal Network from 2011 to 2016. The main outcome was episiotomy, which was identified thanks to the French Common Classification of Medical Procedures. An ascending hierarchical cluster analysis was performed to build the classification. A clinical audit using the classification was conducted yearly in all obstetric units. The episiotomy rates were described throughout the study period for each subgroup of the classification. The OASIS rates were evaluated by subgroup and the association between mediolateral episiotomy and OASIS was investigated for each subgroup.
Our analyses included 81,290 pregnant women. The classification comprised 7 subgroups: nulliparous single cephalic at term, nulliparous single cephalic at term with instrumental delivery, multiparous single cephalic at term, multiparous single cephalic at term with instrumental delivery, all preterm deliveries (< 37 weeks gestation), all breech deliveries, all multiple deliveries. Episiotomy rates ranged from 6.2% in Group 3 to 40.9% in Group 2. From 2011 to 2016, every group except breech deliveries experienced a significant decrease in episiotomy rates, ranging from - 28.1 to - 61.0%. The prevalence of OASIS was the highest in Groups 2 (3.0%) and 4 (2.2%). Overall OASIS rates did not significantly differ with episiotomy use (P = 0.25). However, we found that the use of episiotomy was associated with a reduction in OASIS rates in Groups 1 and 2 (odds ratio 0.6 [95% CI 0.4-0.9] and 0.4 [0.3-0.5], respectively). This reduction was only observed in Group 4 with forceps delivery (odds ratio 0.4 [0.1-0.9]).
We developed the first classification for the evaluation of episiotomy practices based on 7 clinically relevant subgroups. This easy-to-use tool can help obstetricians and midwives improve their practices through self-assessment.
尽管法国的会阴切开率有所下降，但在 2016 年全国围产期调查中，会阴切开率总体仍为 20%。我们旨在制定一种分类方法，以方便分析会阴切开术的实践，并评估会阴切开术是否与每个亚组的产科肛门括约肌损伤（OASIS）发生率降低有关。
这项基于人群的研究纳入了 2011 年至 2016 年勃艮第围产期网络中的所有分娩。主要结局是会阴切开术，通过法国共同医疗程序分类来确定。采用升序层次聚类分析来构建分类。在所有产科单位每年进行一次基于分类的临床审核。描述了整个研究期间分类每个亚组的会阴切开率。评估了 OASIS 发生率，并按亚组进行评估，以及调查正中会阴切开术与 OASIS 之间的关系。
我们的分析纳入了 81290 名孕妇。该分类包括 7 个亚组：足月初产妇、足月初产妇伴器械分娩、足月经产妇、足月经产妇伴器械分娩、所有早产（<37 周妊娠）、所有臀位分娩、所有多胎分娩。会阴切开率从第 3 组的 6.2%到第 2 组的 40.9%不等。2011 年至 2016 年，除臀位分娩外，每个组的会阴切开率均显著下降，范围为-28.1%至-61.0%。OASIS 的患病率在第 2 组（3.0%）和第 4 组（2.2%）中最高。总体 OASIS 率与会阴切开术使用无显著差异（P=0.25）。然而，我们发现会阴切开术与第 1 组和第 2 组 OASIS 率的降低有关（比值比 0.6[95%CI 0.4-0.9]和 0.4[0.3-0.5]）。仅在第 4 组（产钳分娩）中观察到这种降低（比值比 0.4[0.1-0.9]）。
我们基于 7 个临床相关亚组制定了第一个会阴切开术实践评估分类。这种易于使用的工具可以帮助产科医生和助产士通过自我评估来改善他们的实践。
