Lorenz N, Nougtara A, Garner P
Support Centre for International Health, Swiss Tropical Institute, Basel, Switzerland.
Trop Doct. 1998 Apr;28(2):83-5. doi: 10.1177/004947559802800209.
Episiotomy is a common obstetric intervention in many countries of the world, although little is known about rates in African countries. In recent years, the effectiveness of routine episiotomy to prevent severe tears and neonatal asphyxia has been questioned, and evidence shows that the procedure results in considerable maternal morbidity. This study estimates episiotomy rates in Burkina Faso. A high proportion of primigravidae (46%) received an episiotomy when trained midwives attended the delivery; a level which indicates the procedure has to be regarded as routine practice. The episiotomy rate was lower (26%) in primigravidae delivered by auxillary midwives. This proportion is closer to recommended selective approaches derived from good research summaries. The tear rate in women assisted by midwife and auxiliary staff was similar, suggesting that women tear even when the procedure is performed. These results indicate that obstetricians and midwives in Burkina Faso should critically appraise whether routine episiotomy should be abandoned. The introduction of a labour chart is a good vehicle to introduce a policy on avoiding episiotomies.
会阴切开术在世界许多国家都是一种常见的产科干预措施，尽管对非洲国家的实施率了解甚少。近年来，常规会阴切开术预防严重撕裂伤和新生儿窒息的有效性受到质疑，且有证据表明该手术会导致相当程度的产妇发病。本研究对布基纳法索的会阴切开术实施率进行了估算。当受过培训的助产士接生时，初产妇中有很大比例（46%）接受了会阴切开术；这一比例表明该手术已被视为常规操作。由辅助助产士接生的初产妇中，会阴切开术实施率较低（26%）。这一比例更接近基于可靠研究总结得出的推荐性选择性方法。由助产士和辅助人员协助分娩的女性的撕裂伤发生率相似，这表明即使实施了会阴切开术，女性仍会发生撕裂伤。这些结果表明，布基纳法索的产科医生和助产士应审慎评估是否应摒弃常规会阴切开术。引入产程图是推行避免会阴切开术政策的良好手段。
