Rotem Reut, Sela Hen Y, Reichman Orna, Weintraub Adi Y, Grisaru-Granovsky Sorina, Rottenstreich Misgav
Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Jerusalem, affiliated with the Hebrew University Medical School of Jerusalem, 12 Bayit Shaare Zedek Medical Center, Jerusalem 91031, Israel.
Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Jerusalem, affiliated with the Hebrew University Medical School of Jerusalem, 12 Bayit Shaare Zedek Medical Center, Jerusalem 91031, Israel.
Eur J Obstet Gynecol Reprod Biol. 2020 Aug;251:42-47. doi: 10.1016/j.ejogrb.2020.05.028. Epub 2020 May 16.
To assess the frequency of puerperal perineal wound re-suturing, and to evaluate the indications, risk factors and outcomes of this procedure.
A retrospective series of all parturients that underwent puerperal perineal tear suturing between 2005 and 2019 was undertaken. All parturients who required re-suturing during the delivery hospitalization were identified and compared with those who had puerperal perineal wound repair and did not require re-suturing. General demographics, obstetrical history, current delivery characteristics, re-suturing indications, and outcome were obtained and analyzed.
During the study period, 54,934 parturients required puerperal perineal tear suturing, of which 47 (0.09%) required re-suturing within their postpartum hospitalization. Median time from delivery to perineal re-suturing was 5.38 h [IQR 4.07-7.14]. The most common indication was vulvovaginal hematoma (n = 37, 78.7%). The independent risk factors found to be associated with re-suturing were: cephalic malposition (aOR 9.3, 95% CI 1.26-67.74) and meconium stained amniotic fluid (aOR 2.1, 95% CI 1.10-3.85). Parturients who underwent re-suturing had significantly higher rates of postpartum hemorrhage (78.5% vs. 11.4%) blood transfusions (36.2% vs. 1.3%), puerperal fever, and longer hospitalizations (P < 0.01 for all).
In our population, early re-suturing of puerperal perineal tears is rare, however, it is associated with increased short term maternal morbidity.
评估产后会阴伤口再次缝合的频率，并评估该手术的指征、危险因素及结局。
对2005年至2019年间所有接受产后会阴撕裂伤缝合的产妇进行回顾性系列研究。确定所有在分娩住院期间需要再次缝合的产妇，并与接受产后会阴伤口修复且不需要再次缝合的产妇进行比较。获取并分析一般人口统计学资料、产科病史、当前分娩特征、再次缝合指征及结局。
在研究期间，54934名产妇需要进行产后会阴撕裂伤缝合，其中47名（0.09%）在产后住院期间需要再次缝合。从分娩到会阴再次缝合的中位时间为5.38小时[四分位间距4.07 - 7.14]。最常见的指征是外阴阴道血肿（n = 37，78.7%）。发现与再次缝合相关的独立危险因素为：头位异常（调整后比值比9.3，95%置信区间1.26 - 67.74）和羊水粪染（调整后比值比2.1，95%置信区间1.10 - 3.85）。接受再次缝合的产妇产后出血率（78.5%对11.4%）、输血率（36.2%对1.3%）、产褥热发生率及住院时间均显著更高（所有P < 0.01）。
在我们的研究人群中，产后会阴撕裂伤的早期再次缝合很少见，然而，它与产妇短期发病率增加有关。
