河南省助产士和产科医生会阴切开术的知信行调查

Knowledge,attitude and experience of episiotomy practice among obstetricians and midwives in Henan province

目的对公立医院的临床助产工作者对会阴切开术的知识、态度和行为开展调查,探索降低会阴切开在产程中的不规范使用。方法采用便利抽样法,在河南省32所三级医院、47所二级医院、11所一级医院的医生和助产士进行问卷调查。结果 900名临床助产工作者参与了问卷调查。关于过度使用会阴切开术的并发症知识得分情况较好;对初产妇会阴切开术的使用频率与医院等级和工作年限相关,即二级医院使用会阴切开术的频率比三级医院高,差异有统计学意义(P<0.05);年资高的助产士个人会阴切开率较高,差异有统计学意义(P<0.05);仍有42.11%的临床助产工作者认为目前的会阴切开率(45%)正常或过低;产科医生(83.94%)和助产士(79.69%)操作会阴切开术的主要原因是为减少三度或四度会阴裂伤;产科医生(80.29%)和助产士(82.57%)都认为减少会阴切开术最主要的障碍是缺乏"减少会阴裂伤或维持会阴完整性"的培训。结论当前会阴侧切率仍与WHO的推荐存在差异,迫切需要落实相关临床指南,而基层医院和年长的临床助产工作者是需要转变知识和态度的重点培训对象。

Objective After the introduction of restricted episiotomy and laceration suturing guideline, the episiotomy rate is still very high in Henan Province in 2019. The study is to explore the knowledge, attitude and practice towards the practice of episiotomy among clinicians in public hospitals.Methods With a self-administered survey questionnaire, the study was conducted among obstetricians and midwives in 90 public hospitals in Henan province, China.Results We enrolled 900(82. 21%) participants in this questionnaire. It was found that it is higher of participants’ knowledge level on the complications and overuse. However, the episiotomy rate of nulliparouswas identified among participants with a significant difference at hospital level(P< 0. 01). The episiotomy rate in secondary hospitals was higher than the tertiary hospitals. The episiotomy rate also showed different with work experience(P< 0. 05). Less than half of clinicians(42. 11%) considered the current episiotomy rate(45%) was normal or too low.The most common reason for performing episiotomy by obstetricians(83. 94%) and midwives(79. 69%) was the reduction of 3 rd-4 th degree perineal tears. Both obstetricians(80. 29%) and midwives(82. 57 %) agreed that the most significant obstacle to reducing episiotomy rate was lack of training on reducing perineal tears.Conclusion This study confirmed that currentepisiotomy rate is much higher than the recommendation by WHO. It is urgent to fully implement related clinical policies and guidelines.