Djusad Suskhan, Permatasari Intan Indah, Futihandayani Annisa, Shahnaz Puti, Hadiwinata Daniel, Herianti Hana Fathia
Department of Obstetrics and Gynecology, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo National Central Public Hospital, Jakarta, Indonesia.
AJOG Glob Rep. 2024 Jul 17;4(3):100371. doi: 10.1016/j.xagr.2024.100371. eCollection 2024 Aug.
Episiotomy is a surgical procedure involving the enlargement of the posterior vagina to facilitate the delivery of the baby. This study aims to further investigate the associated risk factors for episiotomy and the specific indications for its use in spontaneous labor.
This institutional-based cross-sectional study was conducted among 349 vaginal births with a ratio of 1:4 from January 2020 to December 2020. We recruited study participants using consecutive sampling techniques. The sample size was calculated with a hypothesis test for two population proportions (one-sided test formula). Adjusted odds ratio with the corresponding 95% confidence interval was used to declare the significance of variables.
In our multivariate analysis, it was found that pregnant women who underwent instrumental delivery (-value=.00; OR=25.63; 95% CI: 5.76-114.0) and those with fetal birth weight >3,000 grams (-value=.00; OR=11.31; 95% CI: 3.96-32.32) had the highest risk of undergoing an episiotomy. Subsequently, the duration of the second stage of labor >30 minutes (-value=.049; OR=16.34; 95% CI: 1.01-264.48) was associated with a slightly increased risk of episiotomy. Fetal head circumference >34 cm was not found to be risk of an increased risk of episiotomy in this study. However, pregnant women aged >30 years (-value=.049; OR=0.306; 95% CI: 0.94-0.99) showed a reduced risk of episiotomy.
The prevalence of episiotomy practice in this study exceeds the recommended threshold set by the World Health Organization (WHO). Instrumental delivery, high birth weight, and prolonged second-stage labor emerged as significant factors influencing episiotomy practice. Hence, further interventions are warranted to mitigate the prevalence of episiotomy practice.
会阴切开术是一种外科手术，通过扩大阴道后部来促进胎儿娩出。本研究旨在进一步调查会阴切开术的相关危险因素以及其在自然分娩中的具体使用指征。
本基于机构的横断面研究于2020年1月至2020年12月期间对349例阴道分娩病例进行，抽样比例为1:4。我们采用连续抽样技术招募研究参与者。样本量通过两总体比例的假设检验（单侧检验公式）计算得出。使用调整后的比值比及相应的95%置信区间来判断变量的显著性。
在我们的多变量分析中，发现接受器械助产的孕妇（p值=0.00；比值比=25.63；95%置信区间：5.76 - 114.0）以及出生体重>3000克的胎儿的孕妇（p值=0.00；比值比=11.31；95%置信区间：3.96 - 32.32）进行会阴切开术的风险最高。随后，第二产程持续时间>30分钟（p值=0.049；比值比=16.34；95%置信区间：1.01 - 264.48）与会阴切开术风险略有增加相关。在本研究中，未发现胎儿头围>34厘米与会阴切开术风险增加有关。然而，年龄>30岁的孕妇（p值=0.049；比值比=0.306；95%置信区间：0.94 - 0.99）会阴切开术风险降低。
本研究中会阴切开术的实施率超过了世界卫生组织（WHO）设定的推荐阈值。器械助产、高出生体重和第二产程延长是影响会阴切开术实施的重要因素。因此，有必要采取进一步干预措施以降低会阴切开术的实施率。
