Ali Mahad, Migisha Richard, Ngonzi Joseph, Muhumuza Joy, Mayanja Ronald, Joe Lapat Jolly, Salongo Wasswa, Kayondo Musa
Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, Mbarara, P.O Box 1410, Uganda.
Department of Physiology, Mbarara University of Science and Technology, Mbarara, P.O Box 1410, Uganda.
Obstet Gynecol Int. 2020 May 14;2020:6035974. doi: 10.1155/2020/6035974. eCollection 2020.
Obstetric anal sphincter injuries (OASIS) arise from perineal trauma during vaginal delivery and are associated with poor maternal health outcomes. Most OASIS occur in unattended deliveries in resource-limited settings. However, even in facilities where deliveries are attended by skilled personnel, a number of women still get OASIS.
To determine the incidence and risk factors for obstetric anal sphincter injuries among women delivering at Mbarara Regional Referral Hospital (MRRH).
We conducted an unmatched hospital-based case control study, with the ratio of cases to controls of 1 : 2 (80 cases and 160 controls). We defined a case as a mother who got a third- or fourth-degree perineal tear after vaginal delivery while the controls recruited were the next two mothers who delivered vaginally without a third- or fourth-degree perineal tear. A questionnaire and participants' medical records review were used to obtain sociodemographic and clinical data. We estimated the incidence of OASIS and performed univariable and multivariable logistic regression to identify the associated risk factors.
The cumulative incidence for OASIS during the study period was 6.6%. The risk factors for OASIS were 2 stage of labour ≥1 hour (aOR 6.07, 95%CI 1.86-19.82, =0.003), having episiotomy performed during labour (aOR 2.57, 95%CI 1.07-6.17, =0.035), perineum support during delivery (aOR 0.03, 95%CI 0.01-0.12, < 0.001), and monthly income of >50,000 shillings (aOR 0.09, 95%CI 0.03-0.28, < 0.001). . The risk factors for obstetric anal sphincter injury were prolonged second stage of labour and performing episiotomies during deliveries while higher monthly income and perineum support during delivery were protective. We recommend routine support to the perineum during delivery. Care should be taken in mothers with episiotomies, as they can extend and cause OASIS.
产科肛门括约肌损伤（OASIS）源于阴道分娩时的会阴创伤，与不良的产妇健康结局相关。大多数OASIS发生在资源有限地区的无人照料分娩中。然而，即使在有熟练人员接生的医疗机构中，仍有一些女性会发生OASIS。
确定在姆巴拉拉地区转诊医院（MRRH）分娩的女性中产科肛门括约肌损伤的发生率和危险因素。
我们进行了一项非匹配的基于医院的病例对照研究，病例与对照的比例为1∶2（80例病例和160例对照）。我们将病例定义为阴道分娩后发生三度或四度会阴撕裂的母亲，而招募的对照是接下来两名未发生三度或四度会阴撕裂的阴道分娩母亲。通过问卷调查和查阅参与者的医疗记录来获取社会人口统计学和临床数据。我们估计了OASIS的发生率，并进行单变量和多变量逻辑回归以确定相关的危险因素。
研究期间OASIS的累积发生率为6.6%。OASIS的危险因素包括第二产程≥1小时（调整后比值比[aOR]6.07，95%置信区间[CI]1.86 - 19.82，P = 0.003）、分娩时行会阴切开术（aOR 2.57，95%CI 1.07 - 6.17，P = 0.035）、分娩时会阴支撑（aOR 0.03，95%CI 0.01 - 0.12，P < 0.001）以及月收入>50,000先令（aOR 0.09，95%CI 0.03 - 0.28，P < 0.001）。产科肛门括约肌损伤的危险因素是第二产程延长和分娩时行会阴切开术，而较高的月收入和分娩时的会阴支撑具有保护作用。我们建议在分娩时常规对会阴进行支撑。对行会阴切开术的母亲应予以关注，因为切口可能延长并导致OASIS。
