Schreiber Hanoch, Mevorach Nir, Sharon-Weiner Maya, Farladansky-Gershnabel Sivan, Shechter Maor Gil, Biron-Shental Tal
Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tchernichovsky St., 44281, Kfar Saba, Israel.
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Arch Gynecol Obstet. 2021 Apr;303(4):885-890. doi: 10.1007/s00404-020-05809-7. Epub 2020 Oct 27.
This study evaluated whether episiotomy during vacuum-assisted delivery leads to fewer third- and fourth-degree tears.
This was a retrospective cohort study of all nulliparas who underwent a singleton, soft cup, vacuum-assisted vaginal delivery in one institution, from January 2014 to August 2019. Failed vacuum deliveries were excluded. Based on power analysis calculation, a sample size of 500 women in each group was sufficient to detect an advantage of episiotomy, if present. Primary outcome was third- or fourth-degree perineal tear. Secondary outcomes were other maternal complications, and low neonatal cord pH and Apgar scores. Outcomes were compared between women with and without episiotomy.
During the study period, 2370 nulliparas had a vacuum-assisted vaginal delivery using soft vacuum cup and met the study inclusion criteria. Episiotomy was performed in 1868 (79%) women, and 502 (21%) delivered without episiotomy. Background characteristics were similar in both groups. There were no significant differences in the rates of third and fourth grade perineal lacerations between the two groups. Episiotomy was associated with higher rate of postpartum hemorrhage (p < 0.01) CONCLUSIONS: Using selective episiotomy for patients delivering vaginally with the assistance of soft cap vacuum does not increase third- or fourth-degree perineal tears.
本研究评估了在真空辅助分娩时行会阴切开术是否能减少三度和四度会阴裂伤的发生。
这是一项回顾性队列研究，研究对象为2014年1月至2019年8月在一家机构接受单胎、软杯真空辅助阴道分娩的所有初产妇。排除真空分娩失败的病例。根据功效分析计算，每组500名女性的样本量足以检测会阴切开术（如果存在优势）的优势。主要结局是三度或四度会阴裂伤。次要结局是其他母体并发症以及新生儿脐带血pH值低和阿氏评分低。比较了行会阴切开术和未行会阴切开术的女性的结局。
在研究期间，2370名初产妇使用软真空杯进行了真空辅助阴道分娩并符合研究纳入标准。1868名（79%）女性进行了会阴切开术，502名（21%）未行会阴切开术分娩。两组的背景特征相似。两组之间三度和四度会阴裂伤的发生率无显著差异。会阴切开术与更高的产后出血率相关（p < 0.01）。结论：对使用软帽真空辅助阴道分娩的患者采用选择性会阴切开术不会增加三度或四度会阴裂伤的发生。
