会阴Ⅲ～Ⅳ度裂伤83例临床分析

Clinical analysis of 83 cases of perineal Ⅲ-Ⅳ degree laceration

目的探讨发生会阴重度裂伤(包括会阴Ⅲ~Ⅳ度裂伤)的原因及防治措施。方法对昆明医科大学第一附属医院2010-2016年间经阴道分娩发生会阴重度裂伤的83例病例进行回顾性分析。结果 (1)Ⅲ~Ⅳ度会阴裂伤发生率为0.394%(83/21 083),其中初产妇会阴Ⅲ~Ⅳ度裂伤发生率0.433%(72/16 620),经产妇会阴Ⅲ~Ⅳ度裂伤发生率0.246%(11/4463),两者比较差异有统计学意义(P<0.05)。(2)会阴侧切者Ⅲ~Ⅳ度裂伤发生率0.583%(48/8229),会阴未侧切者Ⅲ~Ⅳ度裂伤发生率为0.272%(35/12 854),两者比较差异有统计学意义(P<0.05)。(3)产钳助产者会阴Ⅲ~Ⅳ度裂伤发生率3.120%(37/1186),头位自然分娩者会阴Ⅲ~Ⅳ度裂伤发生率0.231%(46/19 897),两者比较差异有统计学意义(P<0.05)。(4)会阴切开的产钳助产者会阴Ⅲ~Ⅳ度裂伤发生率为2.911%(28/962),未会阴切开产钳助产者会阴Ⅲ~Ⅳ度裂伤发生率为4.018%(9/224),两者比较差异有统计学意义(P<0.05)。(5)巨大儿会阴Ⅲ~Ⅳ度裂伤发生率为1.225%(11/898);非巨大儿会阴Ⅲ~Ⅳ度裂伤发生率为0.357%(72/20 185),两者比较有差异统计学意义(P<0.05)。(6)第二产程延长会阴Ⅲ~Ⅳ度裂伤发生率2.381%(24/1008);非第二产程延长会阴Ⅲ~Ⅳ度裂伤发生率0.294%(59/20 075),两者比较有差异统计学意义(P<0.05)。结论初产妇、侧切者、产钳助产、未经侧切产钳助产者、胎儿体重偏大者、第二产程延长增加了会阴裂伤发生率。

Objective To investigate the reasons and prevention and treatment measures of acute third-and fourthdegree obstetric lacerations.Methods A retrospective analysis of 83 cases of acute third-and fourth-degree obstetric lacerations in the First Affiliated Hospital of Kunming Medical University from 2010 to 2016 was performed.Results(1)The incidence of 3 rd or 4 th degree laceration was 0.394%(83/21 083),which was 0.433%(72/16 620)in primiparas and 0.246%(11/4463)in multiparous women,there being a statistical difference(P<0.05).(2)The incidence of 3 rd or 4 th degree laceration was significantly increased in the group with episiotomy than without episiotomy[0.583%(48/8229)vs.0.272%(35/12 854),P<0.05].(3)The incidence of 3 rd or 4 th degree laceration was significantly increased in the group with Forceps delivery than without Forceps deliery[3.120%(37/1186)vs.0.231%(46/19 897),P<0.05].(4)In patients with forceps delivery,the incidence of 3 rd or 4 th degree laceration was 2.911%(28/962)in episiotomy group and 4.018%(9/224)in without episiotomy group,there being a significant difference(P<0.05).(5)The incidence of 3 rd or 4 th degree laceration was significantly increased in the macrosomia group than in the non-macrosomia group[1.225%(11/898)vs.0.357%(72/20 185),P<0.05].(6)The incidence of 3 rd or 4 th degree laceration was significantly increased in the prolonged second stage group than in the normal second stage group[2.381%(24/1008)vs.0.294%(59/20 075),P<0.05].Conclusion The incidence of third-and fourth-degree obstetric lacerations is increased in primiparous women,episiotomy,forceps delivery,forceps delivery without episiotomy,big fetal weight and prolonged second stage.