Meyer Raanan, Schwartz Anat, Horesh Nir, Alcalay Menachem, Ram Edward, Levin Gabriel
The Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Ramat-Gan, Israel.
Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Int J Gynaecol Obstet. 2022 May;157(2):271-276. doi: 10.1002/ijgo.13730. Epub 2021 Jun 2.
To develop a risk score for obstetric anal sphincter injury (OASI) occurrence among nulliparous women delivering vaginally, based on data available at admission for delivery and as labor progresses.
A retrospective study of all nulliparous women who delivered vaginally between March 2011 and January 2021. Characteristics were compared between OASI and no-OASI groups. Multivariable analyses were performed to identify independent risk factors for OASI occurrence.
OASI occurred in 453 (1.7%) of 26 081 women who met the inclusion criteria. The following variables were independently associated with OASI: maternal height (adjusted odds ratio [aOR] 0.97, 95% confidence interval (CI) 0.95-0.99), hypertensive disorders (aOR 1.74, 95% CI 1.03-2.95), sonographic fetal weight estimation (aOR 1.00, 95% CI 1.00-1.00), second-stage duration (aOR 1.00, 95% CI 1.00-1.00), occiput posterior position (aOR 2.87, 95% CI 1.79-4.62), and episiotomy performance (aOR 0.63, 95% CI 0.47-0.84). In a risk score based on variables available at admission for delivery, the presence of two factors was associated with 4.3% OASI risk. Upon incorporating intrapartum variables, the presence of two risk factors was associated with 2.9% OASI rate.
A dynamic risk score for OASI occurrence based on data available at admission for delivery and as delivery progresses can assist in counseling regarding OASI risk. A dynamic risk score for obstetric anal sphincter injury occurrence based on data available at admission for delivery and intrapartum was developed.
基于分娩入院时及产程进展中可得的数据，制定一项针对经阴道分娩的初产妇发生产科肛门括约肌损伤（OASI）的风险评分。
对2011年3月至2021年1月期间所有经阴道分娩的初产妇进行回顾性研究。比较了发生OASI组和未发生OASI组的特征。进行多变量分析以确定OASI发生的独立危险因素。
在符合纳入标准的26081名女性中，有453名（1.7%）发生了OASI。以下变量与OASI独立相关：产妇身高（调整后的优势比[aOR]为0.97，95%置信区间[CI]为0.95 - 0.99）、高血压疾病（aOR为1.74，95% CI为1.03 - 2.95）、超声估计胎儿体重（aOR为1.00，95% CI为1.00 - 1.00）、第二产程时长（aOR为1.00，95% CI为1.00 - 1.00）、枕后位（aOR为2.87，95% CI为1.79 - 4.62）以及会阴切开术（aOR为0.63，95% CI为0.47 - 0.84）。在基于分娩入院时可得变量的风险评分中，存在两个因素与4.3%的OASI风险相关。纳入产时变量后，存在两个风险因素与2.9%的OASI发生率相关。
基于分娩入院时及分娩进展中可得数据的OASI发生动态风险评分，有助于就OASI风险进行咨询。基于分娩入院时及产时可得数据制定了产科肛门括约肌损伤发生的动态风险评分。
