会阴切开评估表在限制会阴切开中的研究和应用

The study and use of Episiotomy Evaluation Form in the restrictive use of episiotomy

目的研究会阴切开评估表的制订和应用，为利于不同工龄的助产士对孕妇进行同质化的客观评估，在保证母婴安全的前提下，降低会阴侧切率。方法参考相关文献并结合临床实践，多次讨论并报医院医学伦理委员会审批通过后制订会阴切开评估表，评分内容包括会阴局部病变、会阴弹性、会阴体长度、产妇配合度、孕周、年龄、胎儿宫内窘迫程度、羊水情况、胎儿估计体质量、第二产程时间等，以0、1、3、5、20分进行打分，将600例经产道头位自然分娩的低危初产妇根据随机数字表法随机分为观察组和对照组各300例，观察组严格按照评估表逐项给予打分，并按其使用方法进行操作，对照组则根据助产士的经验和主观认知判断是否行会阴切开术，比较其对母儿的影响。结果观察组会阴侧切率、会阴I。裂伤率分别为15．00％（45／300）、63．00％（189／300），对照组分别为48．33％（145／300）、21．67％（65／300），2组比较差异有统计学意义（X^2=16．238、21．507，P〈0．05）。而2组会阴完整率、会阴正中切开率、会阴Ⅱ。裂伤率、会阴严重裂伤、第二产程时间、产时产后2h出血量、新生儿窒息率、新生儿产伤（臂丛神经损伤、锁骨骨折等）发生率以及产妇42d盆底肌力测定等级方面比较差异均元统计学意义（P〉0．05）。结论在保证母婴安全的前提下，应用限制性会阴切开评估表，可以提高助产士对会阴侧切评估的准确性及同质化，有利于降低会阴侧切率，值得在临床进行推广。

Objective To be good for the different working age midwives to carry out the same evaluation of the pregnant woman, we build and use the Episiotomy Evaluation Form for reducing the rate of episiotomy with ensuring the safety of mother and baby. Methods Consult relevant literature, combine clinical practice, discuss, report to the hospital ethics committee many times and at last it was made after approval. The details included： perineal lesions, perineum elasticity, perineal length, maternal coordination, gestational age, age, fetal distress degree, amniotic fluid situation, the weight of fetus estimated, the second time of labor and so on,to score by 0, 1, 3, 5, 20. A total of 600 patients with low risk of natural childbirth were randomly divided into observation group and control group according to method of random number table with 300 cases each .The observation group was graded according to the perineal incision evaluation and we operated according to its use method. The control group was judged according to the experience of midwife and subjective cognition. At last compared the effects on the mother and baby. Results The rates of lateral episiotomy and I degree laceration were 15.00% （45/300） and 63.00% （189/300） in the observation group and 48.33% （145/300） and 21.67% （65/300） in the control group, respectively. The difference between the two groups was statistically significant （X^2=16.238, 21.507, P 〈 0.05）. There was no statistical difference in the perineal intact rate, median perineal incision rate, perineal II degree laceration rate, severe perineal laceration, second stage of labor, postpartum hemorrhage 2 hours, neonatal asphyxia rate, incidence of neonatal birth injury （braehial plexus injury, clavicle fracture, etc.） and pelvic floor muscle strength of 42 days after delivery between the two groups （P 〉 0.05）. Conclusions By using the episiotomy evaluation form, we can improve the accuracy and homogeneity of the midwife＇s assessment about the episiotomy which is benefit to reduce rate of episiotomy. It is worth promoting in clinical practice but we should ensure the safety of maternal and child.