Villani Federico, Cosmi Erich, Lunardon Zoe, Granci Martina, Panizza Cristina, Mazzucato Barbara, Cavalieri Antonella, Toma Mirela Marioara, Furau Roxana, Furau Cristian
Multidisciplinary Doctoral School, "Vasile Goldis" Western University of Arad, 310414 Arad, Romania.
Department of Women's and Children's Health, University of Padua, 35128 Padua, Italy.
Healthcare (Basel). 2024 Oct 15;12(20):2044. doi: 10.3390/healthcare12202044.
BACKGROUND/OBJECTIVES: Perineal injuries, including episiotomies and spontaneous tears, are common complications during childbirth, often leading to significant discomfort and prolonged recovery for women. This retrospective observational cohort study aimed to explore the relationship between antenatal anovaginal distance (AVD) and the incidence of perineal injuries in a cohort of pregnant women evaluated for pelvic floor health at 28 to 32 weeks of gestation.
Conducted at the University Hospital of Padua over 18 months, the study included 416 women who underwent vaginal delivery at term. Based on AVD, the study participants were divided into two groups: AVD-N group, which included 252 patients with AVD ≥ 2 cm, and the AVD-R group, which included 164 with AVD < 2 cm. The results of the pelvic floor assessment and those related to childbirth were then examined in relation to AVD (reduced vs. normal).
The study found that women with reduced AVD were more likely to experience perineal injuries. Specifically, the incidence of episiotomy and severe perineal tears (3rd and 4th degree) was significantly higher in the reduced AVD group ( < 0.05). Furthermore, a lower AVD was associated with increased perineal muscle hypertonicity and a higher likelihood of operative delivery with episiotomy. Logistic regression analysis confirmed that reduced AVD was an independent risk factor for perineal injuries, regardless of other maternal or neonatal characteristics.
These results suggest that AVD measurement during pregnancy may help identify women at higher risk of perineal trauma, enabling more personalized obstetric care to mitigate these outcomes.
背景/目的：会阴损伤，包括会阴切开术和自然撕裂，是分娩期间常见的并发症，常给女性带来极大不适并延长恢复时间。这项回顾性观察队列研究旨在探讨在妊娠28至32周接受盆底健康评估的一组孕妇中，产前肛阴道距离（AVD）与会阴损伤发生率之间的关系。
该研究在帕多瓦大学医院进行，为期18个月，纳入了416名足月阴道分娩的女性。根据AVD，研究参与者被分为两组：AVD-N组，包括252名AVD≥2 cm的患者；AVD-R组，包括164名AVD<2 cm的患者。然后检查盆底评估结果以及与分娩相关的结果与AVD（降低与正常）的关系。
研究发现，AVD降低的女性更易发生会阴损伤。具体而言，AVD降低组（<0.05）的会阴切开术和严重会阴撕裂（三度和四度）发生率显著更高。此外，较低的AVD与会阴肌肉张力亢进增加以及会阴切开术助产分娩的可能性更高有关。逻辑回归分析证实，无论其他母体或新生儿特征如何，AVD降低都是会阴损伤的独立危险因素。
这些结果表明，孕期测量AVD可能有助于识别会阴创伤风险较高的女性，从而实现更个性化的产科护理以减轻这些后果。
