Aikins Murphy P, Feinland J B
Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, USA.
Birth. 1998 Dec;25(4):226-34. doi: 10.1046/j.1523-536x.1998.00226.x.
Perineal lacerations are a source of significant discomfort to many women. This descriptive study examined perineal outcomes in a home birth population, and provides a preliminary description of factors associated with perineal laceration and episiotomy.
Data were drawn from a prospective cohort study of 1404 intended home births in nurse-midwifery practices. Analyses focused on a subgroup of 1068 women in 28 midwifery practices who delivered at home with a midwife in attendance. Perineal trauma included both episiotomy and lacerations. Minor abrasions and superficial lacerations that did not require suturing were included with the intact perineum group. Associations between perineal trauma and study variables were examined in the pooled dataset and for multiparous and nulliparous women separately.
In this sample 69.6 percent of the women had an intact perineum, 15 (1.4%) had an episiotomy, 28.9 percent had first- or second-degree lacerations, and 7 women (0.7%) had third- or fourth-degree lacerations. Logistic regression analyses showed that in multiparas, low socioeconomic status and higher parity were associated with intact perineum, whereas older age (>/= 40 yr), previous episiotomy, weight gain of over 40 pounds, prolonged second stage, and the use of oils or lubricants were associated with perineal trauma. Among nulliparas, low socioeconomic status, kneeling or hands-and-knees position at delivery, and manual support of the perineum at delivery were associated with intact perineum, whereas perineal massage during delivery was associated with perineal trauma.
The results of this study suggest that it is possible for midwives to achieve a high rate of intact perineums and a low rate of episiotomy in a select setting and with a select population.
会阴撕裂给许多女性带来极大不适。本描述性研究调查了在家分娩人群的会阴结局，并初步描述了与会阴撕裂和会阴切开术相关的因素。
数据取自一项对1404例计划在家由助产士接生的前瞻性队列研究。分析集中于28个助产机构中1068名在家分娩且有助产士在场的女性亚组。会阴创伤包括会阴切开术和撕裂伤。未缝合的轻微擦伤和表浅撕裂伤归入会阴完整组。在汇总数据集中以及分别对经产妇和初产妇，研究了会阴创伤与研究变量之间的关联。
在该样本中，69.6%的女性会阴完整，15例（1.4%）行会阴切开术，28.9%有一度或二度撕裂伤，7例女性（0.7%）有三度或四度撕裂伤。逻辑回归分析显示，经产妇中，低社会经济地位和较高产次与会阴完整相关，而年龄较大（≥40岁）、既往会阴切开术、体重增加超过40磅、第二产程延长以及使用油剂或润滑剂与会阴创伤相关。初产妇中，低社会经济地位、分娩时跪姿或手膝位以及分娩时会阴的人工支撑与会阴完整相关，而分娩时会阴按摩与会阴创伤相关。
本研究结果表明，在特定环境和特定人群中，助产士有可能实现较高的会阴完整率和较低的会阴切开率。
