自然分娩中限制会阴切开的应用

Restrictive use of episiotomy during spontaneous vaginal delivery

目的探索头位初胎自然分娩中实施"限制会阴切开"对产程、严重会阴裂伤、新生儿出生评分的影响。方法自然分娩头位足月初产妇314例作为限制会阴切开组,加强产程观察、产时对胎儿胎心率监测及改进接产手法,对具有明确会阴侧切适应证者实施会阴切开助产,对于无必要者则严格限制会阴切开;以常规会阴切开的单胎、头位、初胎自然分娩者739例为常规组。比较两组新生儿窒息率、会阴阴道裂伤率、各产程时间、产后出血量。结果两组间第一、二、三产程时间差异无统计学意义。限制组产妇出血量稍多于常规组(P<0.01)。轻度新生儿窒息率两组比较差异无统计学意义。结论限制会阴切开的理念与实施,对产程、新生儿出生评分影响不明显,应予推行。

Objective To compare the maternal and neonatal outcomes of restrictive use of episiotomy （only if tearing becomes apparent） versus routine episiotomy （in all cases）. Methods 314 nulliparous women at ≥37 weeks of gestation with live singleton cephalic pregnancies and no contraindication to vaginal birth, who were recruited from November 2010 to March 2011 in this department, received restrictive use of episiotomy while 739 nulliparous women from January to November in 2010 underwent episiotomy as control group. In both groups, we strengthened cardiotoeograph mornitoring and intrapartum care and improved the management of the perineum （ hand on or hand off）. Total duration of labor including the first and the second stages of labour, and blood loss in 2 hours postpartum were recorded as a continuous variable. Apgar scores and anal sphincter （third or fourth degree） tears were also re- corded. Results No significant difference was observed in each stage of labour between the two groups （ P 〉 0.05 ）. Restrictive use of episiotomy resulted in more blood loss than in the control group （ P 〈 0.01 ）. Since the cases with severe perineum tear and neonatal asphyxia in both groups were rare, they were excused from Fisher＇ s exact test. However, the rate of neonatal asphyxia was a little higher in restrictive use group. Conclusions According to this clinical observation, the rate of episiotomy should and could be properly reduced, as the routine and restritive use of episiotomy results in no significant difference in labor duration, anal sphincter tear or neonatal asphyxia.