Department of Obstetrics and Gynecology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China.
Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, and Department of Obstetrics, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, 200092, China.
BMC Pregnancy Childbirth. 2022 Jun 11;22(1):475. doi: 10.1186/s12884-022-04790-0.
To assess the effects of policy of selective versus routine episiotomy on mother and baby for women delivering vaginally in Shanghai and whether the hospital type has any effect on the outcomes.
This was a multi-center retrospective cohort study in Shanghai between March 2015 and May 2017. The study population were vaginal births with selective or routine episiotomy (n = 5478) in 20 secondary or tertiary hospitals. Main Outcome Measure was the incidence of severe perineal lacerations. The adjusted odds ratios (aOR) and 95% confidence intervals (CI) were estimated by logistic regression and presented as the effect sizes. All models were stratified by the utilization of level (secondary and tertiary) and type (general and Obstetric) of hospital.
The primary outcome was not significantly different between vaginal births with routine and selective episiotomy. Patients with selective episiotomy had a lower risk of postpartum hemorrhage, and newborns in the selective episiotomy group had a lower risk of shoulder dystocia and Neonatal Ward compared to those with routine episiotomy. Newborns in selective episiotomy group had a lower risk of birth injury in tertiary hospital. However, newborns in selective episiotomy group had a higher risk of birth injury in general hospitals.
Selective episiotomy is safe and can be recommended over routine episiotomy in obstetric and tertiary hospital settings in China.
评估上海阴道分娩产妇选择性会阴切开术与常规会阴切开术对母婴的影响，以及医院类型是否对结局有影响。
这是 2015 年 3 月至 2017 年 5 月在上海进行的一项多中心回顾性队列研究。研究人群为 20 家二级或三级医院选择性或常规会阴切开术（n=5478）的阴道分娩产妇。主要结局指标为严重会阴裂伤的发生率。采用 logistic 回归估计调整后的优势比（aOR）和 95%置信区间（CI），并以效应大小表示。所有模型均按医院使用的级别（二级和三级）和类型（普通和产科）分层。
常规会阴切开术与选择性会阴切开术分娩的主要结局无显著差异。选择性会阴切开术产妇产后出血风险较低，选择性会阴切开术组新生儿肩难产和新生儿病房入住风险低于常规会阴切开术组。选择性会阴切开术组新生儿在三级医院发生分娩损伤的风险较低。然而，选择性会阴切开术组新生儿在综合医院发生分娩损伤的风险较高。
选择性会阴切开术是安全的，在中国产科和三级医院环境中可推荐替代常规会阴切开术。
