会阴4度裂伤8例临床分析

Treatment of fourth-degree laceration of perineum： an analysis of eight cases

探讨会阴4度裂伤的原因、预防措施及适宜的治疗方法。对2004年1月至2010年12月首都医科大学附属北京妇产医院发生的8例会阴4度裂伤的临床资料进行回顾性分析。接生技术不当成为会阴4度裂伤的主要原因，之后依次为产程过快、胎儿体重与会阴条件适应程度估计不足及阴道助产。8例患者经一期缝合后伤口愈合良好，产后42d均正常排便。提高接产技术及助产技术，产时监测宫缩情况，充分评估胎儿体重及会阴条件和加强产时医患沟通，是预防会阴4度裂伤的关键。

The clinical data of 8 patients with the fourth-degree laceration of perineum, who were admitted in Beijing Obstetrics and Gynecology Hospital, Capital Medical University from January 2004 to December 2010, were reviewed retrospectively. The causes and clinical strategies were analyzed. The fourth- degree laceration of perineum was mainly caused by improper skills of midwifery, too faster labor, insufficient estimation of fetal-weight and perineal condition and obstetric forceps in this group of patients. Primary suture was performed and all cases achieved complete healing. The improvement of midwifery skill, carefully monitoring the uterine contraction, accurate evaluation of condition of perineum and the fetal-weight and good communication between patients and midwives are the key points to prevent the fourth-degree laceration of perineum.