Poen A C, Felt-Bersma R J, Dekker G A, Devillé W, Cuesta M A, Meuwissen S G
Department of Surgery, University Hospital Vrije Universiteit, Amsterdam, The Netherlands.
Br J Obstet Gynaecol. 1997 May;104(5):563-6. doi: 10.1111/j.1471-0528.1997.tb11533.x.
To determine risk factors for third degree obstetric perineal tears and to give recommendations for prevention.
Retrospective case control study.
A teaching hospital in The Netherlands.
One hundred and twenty cases of vaginal delivery complicated by third degree perineal tear and 702 uncomplicated vaginal deliveries were compared, with respect to possible risk factors.
In a multivariate model high birthweight, forceps delivery, induced labour, epidural anaesthesia and parity were risk factors for anal sphincter tear. In addition, mediolateral episiotomy was associated with fewer sphincter injuries. Separate analysis of nulli- and multiparous women demonstrated that high birthweight and epidural anaesthesia (increased risk) and mediolateral episiotomy (decreased risk) were factors associated with anal sphincter tear only in nulliparous women.
We found several risk factors for anal sphincter tear. Nulliparous women are at higher risk than multiparous women. Mediolateral episiotomy may be sphincter-saving especially in nulliparous women and therefore prevent them from chronic faecal incontinence.
确定三度产科会阴撕裂的危险因素并提出预防建议。
回顾性病例对照研究。
荷兰的一家教学医院。
比较120例并发三度会阴撕裂的阴道分娩病例与702例未并发会阴撕裂的阴道分娩病例的可能危险因素。
在多变量模型中，高出生体重、产钳助产、引产、硬膜外麻醉和经产次数是肛门括约肌撕裂的危险因素。此外，会阴侧切术与较少的括约肌损伤相关。对初产妇和经产妇进行单独分析表明，高出生体重和硬膜外麻醉（风险增加）以及会阴侧切术（风险降低）仅在初产妇中是与肛门括约肌撕裂相关的因素。
我们发现了几个肛门括约肌撕裂的危险因素。初产妇比经产妇风险更高。会阴侧切术可能对括约肌有保护作用，尤其是在初产妇中，从而预防她们出现慢性大便失禁。
