Department of Obstetrics and Gynaecology, Our Lady of Lourdes Hospital, Drogheda, Co. Louth, Ireland.
Int Urogynecol J. 2020 Mar;31(3):583-589. doi: 10.1007/s00192-019-04218-y. Epub 2020 Jan 4.
In recent years there has been renewed interest in midwifery-led care for women, with studies reporting similar neonatal outcomes despite lower rates of intervention in midwifery-led birthing centers. Research into obstetric anal sphincter injuries (OASI) in these birthing centers is scarce. The objective of this study was to compare the rate of OASI after spontaneous vaginal delivery in nulliparous women in consultant or midwifery-led units over a ten-year period.
All spontaneous vaginal deliveries in nulliparous women from 2008 to 2017 were analyzed in a single-center retrospective study. Women who had neuraxial analgesia were excluded. The primary endpoint was OASI. Labor characteristics in both groups were compared, and a multiple regression model was created.
During the study period, there were 3260 spontaneous vaginal deliveries in nulliparous women; 75.7% (2467/3260) delivered in the consultant-led unit and 24.3% (793/3260) in the midwifery-led unit (MLU). Women delivering in the MLU had a greater risk of anal sphincter injury than those delivering in the CLU (4.9% [39/793] vs 2.5% [62/2467], OR 2.01, 95% CI 1.32 - 3.01). Significant risk factors that increased the risk of OASI on regression analysis were birthweight and delivery in the midwifery-led unit.
Women delivering in the midwifery-led unit appear to be at double the risk of OASI when compared to those delivering in the consultant-led unit. These results are in contrast to previous studies in midwifery-led centers. This difference may be site-specific and further research is required before these results form part of patient counseling.
近年来，助产士主导的产妇护理再次受到关注，尽管助产士主导的分娩中心的干预率较低，但研究报告新生儿结局相似。对这些分娩中心的产科肛门括约肌损伤（OASI）的研究很少。本研究的目的是比较在 10 年内，在顾问或助产士主导的单位中，初产妇自然分娩后 OASI 的发生率。
在一项单中心回顾性研究中，分析了 2008 年至 2017 年所有初产妇的自然分娩。排除接受椎管内镇痛的妇女。主要结局是 OASI。比较两组的分娩特征，并建立多因素回归模型。
在研究期间，有 3260 名初产妇自然分娩；75.7%（2467/3260）在顾问主导的单位分娩，24.3%（793/3260）在助产士主导的单位分娩（MLU）。与在 CLU 分娩的妇女相比，在 MLU 分娩的妇女发生肛门括约肌损伤的风险更高（4.9%[39/793]比 2.5%[62/2467]，OR 2.01，95%CI 1.32-3.01）。回归分析显示，增加 OASI 风险的显著危险因素是出生体重和在助产士主导的单位分娩。
与在顾问主导的单位分娩的妇女相比，在助产士主导的单位分娩的妇女发生 OASI 的风险似乎增加了一倍。这些结果与之前在助产士主导的中心的研究结果相反。这种差异可能是特定于地点的，需要进一步的研究，然后这些结果才能成为患者咨询的一部分。
