Department of Obstetrics and Gynaecology, Amphia Hospital Breda, the Netherlands.
Department of Medical Informatics, Amsterdam Public Health, Amsterdam UMC, Amsterdam, the Netherlands; Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development, Amsterdam University Medical Center, Location AMC, Amsterdam, the Netherlands.
Eur J Obstet Gynecol Reprod Biol. 2024 Nov;302:294-300. doi: 10.1016/j.ejogrb.2024.09.021. Epub 2024 Sep 20.
Analysis of the association of mediolateral episiotomy (MLE) with obstetric anal sphincter injury (OASI) in women with spontaneous vaginal delivery.
Population-based cohort study with data from the Netherlands Perinatal Registry, describing 541 055 women who delivered a singleton live born infant in cephalic presentation spontaneously at term. Risk indicators for OASI were tested using univariate and multivariate analysis. Additional analysis for the interaction of MLE with other risk indicators was performed.
The rate of OASI was 4.2 % in 215 241 nulliparous and 1.4 % in 325 814 multiparous women. In nulliparous and multiparous women MLE was associated with a reduction of OASI (adjusted OR (aOR) 0.3, 95 % CI 0.30-0.34 and aOR 0.32, 95 % CI 0.30-0.34). The association of MLE with a reduced rate of OASI was stronger in high birthweight and in prolonged 2nd stage groups. In nulliparous women, the number needed to treat (NNT) for the use of MLE to prevent one OASI is 31 in general. With MLE, the OASI rate reduced from 11.5 % to 2.9 with a NNT of 12 in the group with a birth weight ≥ 4000 g and a duration of the second stage of labour of 60-120 min. The NNT is 9 In the group with a birth weight ≥ 4000 g and a duration of the second stage of labour ≥ 120 min (reduction rate of OASI from 14.2 % to 3.5 %).
Use of MLE is associated with a reduction of OASI in spontaneous vaginal delivery. In nulliparous women, an episiotomy with an anticipated birth weight > 4000 g and a duration of the 2nd stage of more than 60 min should be considered.
分析会阴侧切术（MLE）与自发性阴道分娩中产科肛门括约肌损伤（OASI）的关系。
基于人群的队列研究，数据来自荷兰围产期注册中心，描述了 541055 名足月、头位、自发性分娩的单胎活产儿的妇女。使用单变量和多变量分析测试 OASI 的风险指标。对 MLE 与其他风险指标的相互作用进行了额外分析。
在 215241 名初产妇和 325814 名经产妇中，OASI 的发生率分别为 4.2%和 1.4%。在初产妇和经产妇中，MLE 与 OASI 发生率降低相关（调整后的比值比[aOR]0.3，95%CI 0.30-0.34 和 aOR 0.32，95%CI 0.30-0.34）。在高出生体重和第二产程延长的组中，MLE 与 OASI 发生率降低的相关性更强。在初产妇中，使用 MLE 预防 1 例 OASI 的治疗人数（NNT）为 31。使用 MLE，OASI 发生率从 11.5%降至 2.9%，NNT 为 12，适用于出生体重≥4000g 和第二产程 60-120min 的组。NNT 为 9，适用于出生体重≥4000g 和第二产程≥120min 的组（OASI 发生率从 14.2%降至 3.5%）。
在自发性阴道分娩中，使用 MLE 与 OASI 发生率降低相关。对于初产妇，应考虑在预期出生体重>4000g 和第二产程超过 60min 时进行会阴切开术。
