Bączek Grażyna, Rychlewicz Sylwia, Sys Dorota, Rzońca Patryk, Teliga-Czajkowska Justyna
Department of Obstetrics and Gynecology Didactics, Faculty of Health Sciences, Medical University of Warsaw, 00-575 Warsaw, Poland.
St. Sophia's Specialist Hospital, Żelazna Medical Center, 01-004 Warsaw, Poland.
J Clin Med. 2022 Jul 26;11(15):4334. doi: 10.3390/jcm11154334.
The WHO (World Health Organization) recommends that the percentage of perineal incisions should not exceed 10%, indicating that this is a good goal to achieve, despite the fact that it is still a frequently used medical intervention in Poland. The risk factors for perineal incision that have been analyzed so far in the literature allow, among others, to limit the frequency of performing this procedure. Are they still valid? Have there been new risk factors that we should take into account? We have conducted this study to find the risk factors for performing perineal incision that would reduce the frequency of this procedure. The aim of the study was to check whether the risk factors that were analyzed in the literature are still valid, to find new risk factors for perineal incisions and to compare them among Polish women. This was a single-center retrospective case-control study. The electronic patient records of Saint Sophia's Hospital in Warsaw, Poland, a tertiary hospital was used to create an anonymous retrospective database of all deliveries from 2015 to 2020. The study included the analysis of two groups, the study group of patients who had had an episiotomy, and the control group-patients without an episiotomy in cases where an episiotomy was indicated. A logistic regression model was developed to assess the risk factors for perineal laceration. Independent risk factors for episiotomy in labor include oxytocin use in the second stage of labor (OR (Odds Ratio) = 6.00; 95% CI (Confidence Interval): 4.76-7.58), the supply of oxytocin in the first and the second stage of labor (OR = 3.18; 95% CI: 2.90-3.49), oxytocin use in the first stage of labor (OR = 2.72; 95% CI: 2.52-3.51), state after cesarean section (OR = 2.97; 95% CI: 2.52-3.51), epidural anesthesia use (OR = 1.77; 95% CI: 1.62-1.93), male gender (OR = 1.10; 95% CI: 1.02-1.19), and prolonged second stage of labor (OR = 1.01; 95% CI: 1.01-1.01). A protective factor against the use of an episiotomy was delivery in the Birth Centre (OR = 0.43; 95% CI: 0.37-0.51) and mulitpara (OR = 0.31; 95% CI: 0.27-0.35). To reduce the frequency of an episiotomy, it is necessary consider the risk factors of performing this procedure in everyday practice, e.g., limiting the use of oxytocin or promoting alternative places of delivery.
世界卫生组织（WHO）建议会阴切开术的比例不应超过10%，这表明尽管在波兰它仍是一种常用的医疗干预措施，但这是一个值得实现的良好目标。迄今为止，文献中分析的会阴切开术的风险因素有助于（尤其）限制该手术的实施频率。它们仍然有效吗？是否出现了我们应考虑的新风险因素？我们开展这项研究以找出可降低会阴切开术频率的相关风险因素。该研究的目的是检验文献中分析的风险因素是否仍然有效，找出会阴切开术的新风险因素，并在波兰女性中对这些因素进行比较。这是一项单中心回顾性病例对照研究。利用波兰华沙圣索菲亚医院（一家三级医院）的电子病历创建了一个2015年至2020年所有分娩的匿名回顾性数据库。该研究包括两组分析，即接受会阴切开术的患者研究组，以及在有会阴切开术指征的情况下未接受会阴切开术的患者对照组。建立了一个逻辑回归模型来评估会阴裂伤的风险因素。分娩时会阴切开术的独立风险因素包括第二产程使用缩宫素（比值比（OR）=6.00；95%置信区间（CI）：4.76 - 7.58）、第一产程和第二产程均使用缩宫素（OR = 3.18；95% CI：2.90 - 3.49）、第一产程使用缩宫素（OR = 2.72；95% CI：2.52 - 3.51）、剖宫产术后状态（OR = 2.97；95% CI：2.52 - 3.51）、使用硬膜外麻醉（OR = 1.77；95% CI：1.62 - 1.93）、男性胎儿（OR = 1.10；95% CI：1.02 - 1.19）以及第二产程延长（OR = 1.01；95% CI：1.01 - 1.01）。分娩中心分娩（OR = 0.43；95% CI：0.37 - 0.51）和经产妇（OR = 0.31；95% CI：0.27 - 0.35）是防止使用会阴切开术的保护因素。为降低会阴切开术的频率，有必要在日常实践中考虑实施该手术的风险因素，例如限制缩宫素的使用或推广替代分娩地点。
