无保护会阴分娩初产妇会阴裂伤的危险因素分析

Analysis of risk factors of perineal laceration of primipara during unprotected transvaginal delivery

目的:探究无保护会阴分娩初产妇会阴裂伤危险因素,为助产自然分娩产妇会阴裂伤的早期预防及干预提供新的参考资料.方法:选择2021年1-12月本院实施无保护会阴分娩的376例初产妇为研究对象,根据是否发生阴裂伤分为裂伤组236例,未裂伤组140例,采用logistic回归分析模型分析无保护会阴分娩初产妇会阴裂伤危险因素.结果:376例初产妇发生会阴裂伤的236例,占62.8%,其中Ⅰ度裂伤219例,占92.8%.多因素logistic回归分析显示,第二产程时间延长(OR=2.307,95%CI1.305~2.842)、产前会阴水肿(OR=2.825,95%CI1.364~4.810)、新生儿体重≥3.5kg(OR=3.570,95%CI1.601~5.825)、分娩恐惧(OR=1.542,95%CI1.240~2.133)是初产妇会阴裂伤的独立危险因素;助产士年资≥5年(OR=0.410,95%CI0.265~0.730)和孕期充分的体力活动(OR=0.603,95%CI 0.413~0.901)是无保护会阴分娩初产妇会阴裂伤的保护因素.结论:无保护会阴分娩初产妇会阴裂伤率较高,但以轻度裂伤为主,临床医护人员应对产前及产时会阴裂伤相关危险因素重点关注,积极采取预防干预措施,以降低会阴裂伤发生率及裂伤程度.

Objective: To explore the risk factors of perineal laceration of primipara during unprotected transvaginal delivery so as to provide new evidences for the early prevention and intervention of perineal laceration during transvaginal delivery. Methods: A total of 376 primiparas who experienced unprotected transvaginal delivery were selected and were divided into 236 cases with perineal laceration in group A and 140 cases without perineal laceration in group B from January 2021 to December 2021. The risk factors of perineal laceration of the primiparas were analyzed by Logistic regression analysis model. Results: In 376 primiparas, there were 236(62.8%) cases with perineal laceration, which included 219 cases(92.8%) with grade Ⅰof perineal laceration. Multivariate Logistic regression analysis showed that prolonged duration of the second stage of labor(OR=2.307, 95%CI 1.305-2.842), the prenatal perineal edema(OR=2.825, 95%CI 1.364-4.810), the neonatal weight ≥3.5 kg(OR=3.570, 95%CI 1.601-5.825), and the fear of delivery(OR=1.542, 95%CI 1.240-2.133) of the primiparas were their independent risk factors of perineal lacerations. The seniority of midwife with working times ≥5 years(OR=0.410, 95%CI 0.265-0.730) and the adequate physical activity of the primiparas during pregnancy(OR=0.603, 95%CI 0.413-0.901) were their protective factors of perineal laceration. Conclusion: The rate of perineal laceration of the primiparas during unprotected transvaginal delivery is higher, which mainly is mild laceration. Clinical medical staff should pay attention to the risk factors related to perineal laceration before and during delivery, and should take preventive and intervention measures actively to reduce the incidence and severity of perineal laceration of the primiparas.