Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet and the Department of Obstetrics and Gynecology, Danderyd Hospital, Stockholm, Sweden.
Department of Women's and Children's Health and Centre for Clinical Research Dalarna and Uppsala University, Uppsala, Sweden.
Eur J Obstet Gynecol Reprod Biol. 2022 Feb;269:62-70. doi: 10.1016/j.ejogrb.2021.12.017. Epub 2021 Dec 21.
Correct episiotomy use and technique may prevent obstetric anal sphincter injuries. We aimed to explore the attitudes, use, and technique regarding episiotomy among doctors in Sweden, and their willingness to contribute to a randomized controlled trial of lateral episiotomy or no episiotomy in vacuum extraction in nulliparous women.
A web-based survey was sent to members of the Swedish Society of Obstetrics and Gynecology (n = 2140). The survey included 31 questions addressing personal characteristics, use of episiotomy, a two-dimensional picture on which the respondents drew an episiotomy, and questions regarding attitudes towards episiotomy and participation in a randomized controlled trial. We calculated the proportion of supposedly protective episiotomies (fulfilling criteria of a lateral or mediolateral episiotomy and a length ≥ 30 mm). We compared the results between obstetricians, gynecologists, and residents using Chi-square and Kruskal-Wallis tests for differences between groups, and logistic regression to estimate the odds ratio (OR) of drawing a protective episiotomy.
We received 432 responses. Doctors without a vacuum delivery in the past year were excluded, leaving 384 respondents for further analyses. In all, 222 (57.8%) doctors reported use of episiotomy in<50% of vacuum extractions. We obtained 308 illustrated episiotomies with a median angle of 53°, incision point distance from the midline of 21 mm, and length of 36 mm, corresponding to a lateral episiotomy. Few doctors combined these parameters correctly resulting in 167 (54.2%) incorrectly drawn episiotomies. Residents drew shorter episiotomies than obstetricians and gynecologists. Doctors ranked episiotomy the least important intervention to prevent obstetric anal sphincter injuries in vacuum extraction. Doctors contributing to an ongoing randomized controlled trial of lateral episiotomy or no episiotomy in vacuum extraction were more able to draw a protective episiotomy (OR 3.69, 95% confidence interval 1.94-7.02).
Doctors in Sweden reported restrictive use of episiotomy in vacuum extraction and depicted lateral type episiotomies, although the majority were incorrectly drawn. Preventive episiotomy was ranked of low importance. Our results imply a need for education, training, and guidelines to increase uptake of correct episiotomy technique, which could result in improved prevention of obstetric anal sphincter injuries.
正确使用和操作会阴切开术可预防产科肛门括约肌损伤。本研究旨在探讨瑞典医生在会阴切开术中的态度、使用情况和技术，并探讨他们对一项随机对照试验的意愿，即在初产妇行真空吸引分娩中采用会阴侧切术或不侧切。
我们向瑞典妇产科协会的成员（n=2140 人）发送了一份网络调查问卷。该调查问卷包括 31 个问题，涉及个人特征、会阴切开术的使用、二维图片上的会阴切开术绘图以及对会阴切开术的态度和参与随机对照试验的意愿。我们计算了假设的保护性会阴切开术的比例（符合侧会阴切开术或中外侧会阴切开术标准，长度≥30mm）。我们使用卡方检验和 Kruskal-Wallis 检验比较了产科医生、妇科医生和住院医生之间的结果差异，并使用逻辑回归估计了绘制保护性会阴切开术的比值比（OR）。
我们共收到 432 份回复。排除了过去一年中没有行真空分娩的医生，留下 384 名医生进行进一步分析。共有 222 名（57.8%）医生报告在<50%的真空分娩中使用会阴切开术。我们共获得 308 张会阴切开术绘图，中位数角度为 53°，切口距中线距离为 21mm，长度为 36mm，对应侧会阴切开术。很少有医生能正确地结合这些参数，导致 167 名（54.2%）医生绘制的会阴切开术不正确。住院医生绘制的会阴切开术长度比产科医生和妇科医生短。医生认为会阴切开术是预防真空分娩中产科肛门括约肌损伤的最不重要的干预措施。参与正在进行的侧会阴切开术或不会阴切开术的随机对照试验的医生更能绘制出保护性的会阴切开术（OR 3.69，95%置信区间 1.94-7.02）。
瑞典医生报告在真空分娩中会阴切开术的使用率较低，并描述了外侧类型的会阴切开术，尽管大多数都绘制不正确。预防性会阴切开术的重要性排名较低。我们的研究结果表明，需要进行教育、培训和制定指南，以提高正确会阴切开术技术的使用率，从而改善产科肛门括约肌损伤的预防效果。
