The Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
The Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Ramat-Gan, Israel.
Arch Gynecol Obstet. 2020 Jan;301(1):171-177. doi: 10.1007/s00404-020-05444-2. Epub 2020 Jan 27.
Most professional guidelines advise against routine episiotomy during vaginal delivery, although mounting evidence supports its protective role regarding obstetric anal sphincter injury (OASI). We aimed to study the effect of lateral and mediolateral episiotomies on the rate of OASI in relation to birthweight among nulliparous women undergoing vaginal delivery.
A historical cohort study was conducted of all nulliparous women who delivered vaginally at term between 2011 and 2019 at a tertiary university hospital. Women were allocated into two groups: (1) with OASI and (2) without OASI. Episiotomy performance and birthweight groups were analyzed.
Overall, 22,250 deliveries were analyzed for inclusion: 18,533 (83.3%) spontaneous vaginal deliveries (SVD), 3222 (14.5%) vacuum-assisted deliveries (VAD) and 495 (2.2%) forceps deliveries. Total episiotomy and OASI rate was 48.2% and 1.7%, respectively. Episiotomy rate was lower in the OASI group as compared to the no OASI group (158 (41.3%) vs. 10,568 (48.3%), OR 0.75, 0.61-0.92, p = 0.006). Median birthweight was higher for OASI group neonates (3355 vs. 3160, p < 0.001). In SVDs, episiotomy decreased the rate of OASI in neonatal birthweight groups of 3000-3499, 3500-3999 and > 4000 g (OR 0.56, 0.38-0.82, p = 0.003; 0.66, 0.45-0.99, p = 0.04 and 0.24, 0.07-0.78, p = 0.01, respectively). In VADs, episiotomy decreased the rate of OASI in the neonatal weight groups of 2500-2999 and 3000-3499 g (OR 0.36, 0.14-0.89, p = 0.02 and OR 0.38, 0.19-0.75, p = 0.004, respectively).
Lateral and mediolateral episiotomies are independent modifiable predictors of OASI, protective against OASI in SVDs when neonates weigh > 3000 g and 2500-3499 g in VADs.
大多数专业指南建议避免在阴道分娩时常规施行会阴切开术，尽管越来越多的证据支持其对产科肛门括约肌损伤（OASI）的保护作用。我们旨在研究在阴道分娩的初产妇中，横向和中外侧会阴切开术与出生体重对 OASI 发生率的影响。
对 2011 年至 2019 年在一家三级大学医院阴道分娩的所有初产妇进行了一项历史性队列研究。将产妇分为两组：（1）有 OASI 和（2）无 OASI。分析会阴切开术表现和出生体重组。
总体上，分析了 22250 例纳入的分娩：18533 例（83.3%）自发性阴道分娩（SVD）、3222 例（14.5%）真空辅助分娩（VAD）和 495 例（2.2%）产钳分娩。会阴切开术总发生率和 OASI 发生率分别为 48.2%和 1.7%。与无 OASI 组相比，OASI 组的会阴切开术发生率较低（158（41.3%）比 10568（48.3%），OR 0.75，0.61-0.92，p=0.006）。OASI 组新生儿的中位出生体重较高（3355 比 3160，p<0.001）。在 SVD 中，会阴切开术降低了新生儿出生体重组 3000-3499、3500-3999 和>4000 g 的 OASI 发生率（OR 0.56，0.38-0.82，p=0.003；0.66，0.45-0.99，p=0.04 和 0.24，0.07-0.78，p=0.01，分别）。在 VAD 中，会阴切开术降低了新生儿体重 2500-2999 和 3000-3499 g 组的 OASI 发生率（OR 0.36，0.14-0.89，p=0.02 和 OR 0.38，0.19-0.75，p=0.004，分别）。
横向和中外侧会阴切开术是 OASI 的独立可改变预测因子，在 SVD 中当新生儿体重>3000 g 和 VAD 中 2500-3499 g 时，可预防 OASI。
