Department of Obstetrics and Gynaecology, Shrewsbury and Telford Hospitals NHS Trust, Telford, United Kingdom.
School of Health Sciences, University of Western Macedonia, Kozani, Greece.
J Womens Health (Larchmt). 2021 May;30(5):681-688. doi: 10.1089/jwh.2019.8244. Epub 2020 Sep 9.
To determine the incidence of and predictors for obstetric anal sphincter injuries (OASIS) and intact perineum in women giving birth in the water and compare with the general obstetric population. Data were retrospectively collected for women who had singleton cephalic presentation vaginal births in the water and the general obstetric population between August 2007 and December 2017. We identified 1,007 women who had a waterbirth and 36,924 women from the general obstetric population. There was no significant difference in the incidence of OASIS between waterbirths and the general obstetric population (2.3% vs. 2.0%). Having a waterbirth was associated with a lower probability for an intact perineum (odds ratio [OR] = 0.83; confidence interval [95% CI]: 0.73-0.94) when compared with the general obstetric population (44.7% vs. 51.3%). Nulliparous women with a waterbirth when compared with multiparous women had an eightfold higher likelihood for the occurrence of OASIS (OR = 8.28; 95% CI: 2.64-25.86). The risk for a higher degree of OASIS was associated with increased maternal age in the total sample (OR = 1.08; 95% CI: 1.06-1.11) and with a lower body mass index (BMI) at booking in multiparous women (OR = 0.96; 95% CI: 0.92-0.99). The risk for any type of perineal trauma was associated with increased maternal age in the total sample (OR = 1.10; 95% CI: 1.07-1.13) and with a lower BMI at booking in multiparous women (OR = 0.95; 95% CI: 0.91-0.99). We found that giving birth in the water reduced the chance of having an intact perineum. We have also shown that nulliparity, increased maternal age in all women, and a lower BMI at booking in multiparous were associated with OASIS and lower rates of intact perineum in waterbirths.
确定水中分娩产妇发生产科肛门括约肌损伤（OASIS）和会阴完整的发生率及其预测因素，并与一般产科人群进行比较。
回顾性收集了 2007 年 8 月至 2017 年 12 月期间，单胎头位阴道分娩的水中分娩产妇和一般产科人群的资料。共纳入 1007 例水中分娩产妇和 36924 例一般产科人群。水中分娩产妇的 OASIS 发生率与一般产科人群无显著差异（2.3%比 2.0%）。与一般产科人群相比，水中分娩产妇发生会阴完整的可能性更低（比值比[OR]＝0.83；95%置信区间[95%CI]：0.73-0.94）（44.7%比 51.3%）。与经产妇相比，初产妇水中分娩发生 OASIS 的可能性高 8 倍（OR＝8.28；95%CI：2.64-25.86）。在总样本中，OASIS 程度较高与产妇年龄增加相关（OR＝1.08；95%CI：1.06-1.11），与经产妇初诊 BMI 降低相关（OR＝0.96；95%CI：0.92-0.99）。在总样本中，所有类型的会阴创伤与产妇年龄增加相关（OR＝1.10；95%CI：1.07-1.13），与经产妇初诊 BMI 降低相关（OR＝0.95；95%CI：0.91-0.99）。
水中分娩降低了会阴完整的可能性。我们还发现，初产妇、所有产妇的年龄增加以及经产妇初诊 BMI 降低与 OASIS 和水中分娩时会阴完整率降低有关。
