阿富汗喀布尔沙赫拉腊教学医院会阴切开术的患病率及相关因素
The prevalence of episiotomy and associated factors at Shahrara Teaching Hospital in Kabul, Afghanistan.
作者信息
Golzareh Parvin, Sultani Sadaf, Mann Erin M, Mohammadi Khair Mohammad
机构信息
Enhanced Midwifery Skills Department, School of Midwifery, Kabul University of Medical Sciences "Abu Ali Ibn Sina", Kabul, Afghanistan.
Center for Global Health and Social Responsibility, University of Minnesota, Mayo Building Suite C311, MMC 329 420 Delaware St SE, Minneapolis, MN, 55455, USA.
出版信息
BMC Pregnancy Childbirth. 2025 Jan 31;25(1):101. doi: 10.1186/s12884-025-07190-2.
BACKGROUND
Episiotomy is done to expand the birth canal but can cause serious complications. It is still commonly performed in many parts of the world representing a quality-of-care and quality-of-life challenge. There is currently no data regarding the prevalence of episiotomy in Afghanistan. The aim of this study was to determine the prevalence of episiotomy and associated factors in women who delivered at a teaching hospital in Kabul, Afghanistan.
METHODS
A retrospective, cross-sectional study was conducted at Shahrara Teaching Hospital. The study sample included all women at Shahrara Teaching Hospital with vaginal delivery during the first six months of 2023. Demographic and clinical information was gathered from medical records. Descriptive statistics were calculated. Logistic regression was performed to assess the independent predictors of episiotomy.
RESULTS
A total of 1,288 women had vaginal delivery during the study period and 306 (23.76%) delivered using episiotomy. Higher parity was associated with lower odds of episiotomy (OR: 0.01 95% CI 0.007-0.022; p < 0.0001) and a longer duration of labor during stage 2 was associated with higher odds of episiotomy (OR: 1.04 95% CI 1.01-1.07; p = 0.02). An association between Apgar score at the first minute of birth was also associated with higher odds of episiotomy (OR: 1.72 95% CI 0.98-3.03; p = 0.06) although this did not reach statistical significance at a value of p < 0.05. Also of note, the majority of patients received oxytocin (72.2%) and only 1 vacuum delivery was performed representing two additional quality-of-care issues.
CONCLUSIONS
This study is the first to estimate the prevalence of episiotomy in Afghanistan. The rate of episiotomy found in this study was higher than WHO recommendations but lower compared to studies from other low-income or middle-income countries in Asia and Africa. Additional efforts, including national guidelines or policies and workforce training, are needed to further reduce the rate.
背景
会阴切开术用于扩大产道，但可能导致严重并发症。在世界许多地区，该手术仍普遍施行，这对医疗质量和生活质量构成了挑战。目前尚无关于阿富汗会阴切开术患病率的数据。本研究的目的是确定在阿富汗喀布尔一家教学医院分娩的女性中会阴切开术的患病率及相关因素。
方法
在沙赫拉教学医院开展了一项回顾性横断面研究。研究样本包括2023年前六个月在沙赫拉教学医院经阴道分娩的所有女性。从医疗记录中收集人口统计学和临床信息。进行描述性统计分析。采用逻辑回归分析评估会阴切开术的独立预测因素。
结果
在研究期间，共有1288名女性经阴道分娩，其中306名（23.76%）采用了会阴切开术。较高的产次与会阴切开术的较低发生率相关（比值比：0.01，95%置信区间0.007 - 0.022；p < 0.0001），第二产程较长的产程与会阴切开术的较高发生率相关（比值比：1.04，95%置信区间1.01 - 1.07；p = 0.02）。出生后第一分钟的阿氏评分与会阴切开术的较高发生率也存在关联（比值比：1.72，95%置信区间0.98 - 3.03；p = 0.06），尽管在p < 0.05时未达到统计学显著性。同样值得注意的是，大多数患者接受了催产素（72.2%），仅进行了1例真空助产，这代表了另外两个医疗质量问题。
结论
本研究首次对阿富汗会阴切开术的患病率进行了估计。本研究中发现的会阴切开术发生率高于世界卫生组织的建议，但与亚洲和非洲其他低收入或中等收入国家的研究相比要低。需要做出更多努力，包括制定国家指南或政策以及开展劳动力培训，以进一步降低该发生率。
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