McCandlish R, Bowler U, van Asten H, Berridge G, Winter C, Sames L, Garcia J, Renfrew M, Elbourne D
National Perinatal Epidemiology Unit, Oxford, UK.
Br J Obstet Gynaecol. 1998 Dec;105(12):1262-72. doi: 10.1111/j.1471-0528.1998.tb10004.x.
To compare the effect of two methods of perineal management used during spontaneous vaginal delivery on the prevalence of perineal pain reported at 10 days after birth.
Randomised controlled trial.
Two English maternity care units.
5471 women who gave birth between December 1994 and December 1996.
At the end of the second stage of labour women were allocated to either the 'hands on' method, in which the midwife's hands put pressure on the baby's head and support ('guard') the perineum; lateral flexion is then used to facilitate delivery of the shoulders, or the 'hands poised' method, in which the midwife keeps her hands poised, not touching the head or perineum, allowing spontaneous delivery of the shoulders.
Perineal pain in the previous 24 hours reported by women in self-administered questionnaire 10 days after birth.
Questionnaires were completed by 97% of women at 10 days after birth. 910 (34.1%) women in the 'hands poised' group reported pain in the previous 24 hours compared with 823 (31.1%) in the 'hands on' group (RR 1.10, 95% CI 1.01 to 1.18: absolute difference 3%, 0.5% to 5%, P = 0.02). The rate of episiotomy was significantly lower in the 'hands poised' group (RR 0.79, 99% CI 0.65 to 0.96, P = 0.008) but the rate of manual removal of placenta was significantly higher (RR 1.69, 99% CI 1.02 to 2.78; P = 0.008). There were no other statistically significant differences detected between the two methods.
The reduction in pain observed in the 'hands on' group was statistically significant and the difference detected potentially affects a substantial number of women. These results provide evidence to enable individual women and health professionals to decide which perineal management is preferable.
比较自然阴道分娩时两种会阴处理方法对产后10天报告的会阴疼痛发生率的影响。
随机对照试验。
两个英国产科护理单位。
1994年12月至1996年12月期间分娩的5471名妇女。
在第二产程结束时，将产妇分为“手法辅助”组，即助产士用手对胎儿头部施加压力并支撑（“保护”）会阴；然后通过侧屈来协助娩出肩部；或“手法悬置”组，即助产士将手悬置，不接触头部或会阴，让肩部自然娩出。
产后10天妇女通过自行填写问卷报告的前24小时内的会阴疼痛情况。
97%的妇女在产后10天完成了问卷。“手法悬置”组910名（34.1%）妇女报告前24小时有疼痛，而“手法辅助”组为823名（31.1%）（相对危险度1.10，95%可信区间1.01至1.18：绝对差异3%，0.5%至5%，P = 0.02）。“手法悬置”组会阴切开率显著较低（相对危险度0.79，99%可信区间0.65至0.96，P = 0.008），但人工剥离胎盘率显著较高（相对危险度1.69，99%可信区间1.02至2.78；P = 0.008）。两种方法之间未检测到其他具有统计学意义的差异。
“手法辅助”组观察到的疼痛减轻具有统计学意义，且检测到的差异可能影响大量妇女。这些结果为个体妇女和健康专业人员决定哪种会阴处理方法更可取提供了证据。
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