基于限制性会阴切开评估工具联合俯屈助娩降低会阴切开率的研究

Study on reducing perineal incision rate based on restrictive perineal incision evaluation tool combined with prone flexion delivery

目的探讨限制性会阴切开评估联合俯屈助娩法对降低会阴切开率的影响。方法采用便利抽样法, 选取2020年6-11月在南京医科大学附属无锡人民医院顺产分娩的440名初产妇为研究对象, 根据随机数字表法将初产妇分为观察组和对照组, 各220名。观察组按限制性会阴切开评估量表逐项打分, 根据最终评分严格执行会阴切开指征;对照组根据主观经验判断是否进行会阴切开, 两组均采取俯屈助娩法接产, 比较两组产妇的分娩结局。结果观察组会阴切开率低于对照组, 差异具有统计学意义(P<0.01), 观察组会阴裂伤程度较对照组轻, 差异有统计学意义(P<0.05)。观察组产后会阴伤口愈合不良率低于对照组, 差异具有统计学意义(P<0.05)。观察组产后会阴疼痛程度较对照组轻, 差异有统计学意义(P<0.01)。两组新生儿窒息发生率比较差异无统计学意义(P>0.05)。两组均未发生新生儿产伤。结论限制性会阴切开评估量表的构建和运用, 避免助产士根据主观经验判断, 提高会阴切开评估准确性。结合俯屈助娩法进一步降低了会阴切开率和产后会阴伤口愈合不良率, 可减轻产妇产后会阴疼痛, 是能改善产后会阴结局又能确保母婴安全的有效方法。

Objective To explore the effect of restrictive perineal incision evaluation combined with prone flexion delivery on reducing the perineal incision rate.Methods The convenient sampling method was used to select 440 primiparas who delivered naturally in Wuxi People's Hospital Affiliated to Nanjing Medical University from June to November 2020 as research objects.According to the random number table method,the primiparas were divided into the observation group and the control group,with 220 cases in each group.The observation group was scored item by item according to the Restrictive Perineotomy Assessment Scale,and the indications of perineotomy were strictly performed according to the final score.The control group judged whether to undergo perineotomy according to subjective experience.The prone flexion delivery was used in both groups and the delivery outcomes of the two groups were compared.Results The perineal incision rate of the observation group was lower than that of the control group,and the difference was statistically significant(P<0.01).The perineal laceration degree of the observation group was less than that of the control group,and the difference was statistically significant(P<0.05).The rate of poor perineal wound healing in the observation group was lower than that in the control group,and the difference was statistically significant(P<0.05).The degree of postpartum perineal pain in the observation group was less than that in the control group,and the difference was statistically significant(P<0.01).There was no statistically significant difference in the incidence of neonatal asphyxia between the two groups(P>0.05).There was no neonatal injury in the two groups.Conclusions Construction and application of Restrictive Perineotomy Assessment Scale avoid midwives to judge based on subjective experience and improve the accuracy of perineotomy assessment.The combination with prone flexion delivery can further reduce the rate of perineotomy and poor healing rate of postpartum perineal wound and reduce postpartum perineal pain,which is an effective method to improve postpartum perineal outcome and ensure the safety of mother and children.