低危初产妇正常分娩会阴侧切的病例对照研究

Case-control Study of Lateral Episiotomy in Spontaneous Vaginal Delivery of Low-Risk Primiparas

目的比较在低危初产妇正常分娩中,会阴侧切者与未侧切者之间母儿结局,以更加合理地应用该手术。方法回顾性病例资料对照分析。在某院选取某一时期头位、单胎、正常分娩的低危初产妇,并由中级助产师接产,组成样本。记录母儿结局。分析应用会阴侧切组与未侧切组之间母儿结局,并比较不同接产人员间会阴侧切率与母儿结局。结果会阴侧切组与不侧切组初产妇年龄、孕周、新生儿体质量一般情况比较差异无统计学意义,组间具有可比性;两组在产程时间、新生儿评分方面比较差异均无统计学意义,会阴侧切组有更多的产后出血,差异有统计学意义(t=3.431,P=0.001)。会阴侧切组与未侧切组新生儿1 min窒息发生率和5 min窒息发生率比较差异无统计学意义(P=0.886、P=0.261)。6名助产士接产的产妇会阴侧切率差异很大,分别为33.0%、83.3%、87.8%、90.6%、90.7%、94.2%,差异有统计学意义(P=0.000),但6组新生儿窒息发生率比较差异无统计学意义。结论会阴侧切与不侧切之间,母儿结局比较差异无统计学意义,不支持会阴侧切能够缩短产程和预防胎儿窒息。在低危初产妇正常分娩中,会阴侧切的应用在不同的助产士之间差异巨大,提示助产士是影响会阴侧切应用的重要因素。鉴于会阴侧切潜在的危害,应加强指征控制,加强会阴保护与会阴侧切规范化操作培训,提高助产士自身实践水平与判断能力。对于低危初产妇正常分娩不应常规进行会阴侧切。

Objective To compare different maternal and neonatal outcomes of low risk primiparas with and without episiotomy in spontaneous vaginal delivery.Methods 400 cases of low-risk primiparas with head position,singleton and normal laboring were divided into episiotomy group and non-episiotomy group with case-control study.Maternal and neonatal outcomes were observed.Rate of episiotomy among different midwives also analyzed.Results There was no statistical difference of age,pregnant week,labor process,Apgar score and neonatal birth weight in two groups.The rates of asphyxia at 1 minute（P=0.886） and at 5 minute（P=0.261） were of no statistical difference between two groups.There were more patients with postpartum bleeding in episiotomy group（t=3.431,P=0.001）.Rates of episiotomy from 6 midwives varied from33.0%,83.3%,87.8%,90.6%,90.7%,94.2% respectively（P=0.000）.There was no statistical difference of the comparison of asphyxia incidences.Conclusion Maternal and neonatal outcomes are of no statistical difference between primiparous women with episiotomy and those without,but there is more postpartum bleeding in women with episiotomy.The episiotomy incidence varies greatly among different midwives.More training on episiotomy should be provided for midwives and routine use of episiotomy in low-risk women with normal birth is not advocated.