低危初产妇正常分娩会阴侧切的病例对照研究

目的 比较在低危初产妇正常分娩中,会阴侧切者与未侧切者之间母儿结局,以更加合理地应用该手术.方法 回顾性病例资料对照分析.在某院选取某一时期头位、单胎、正常分娩的低危初产妇,并由中级助产师接产,组成样本.记录母儿结局.分析应用会阴侧切组与未侧切组之间母儿结局,并比较不同接产人员间会阴侧切率与母儿结局.结果 会阴侧切组与不侧切组初产妇年龄、孕周、新生儿体质量一般情况比较差异无统计学意义,组间具有可比性;两组在产程时间、新生儿评分方面比较差异均无统计学意义,会阴侧切组有更多的产后出血,差异有统计学意义(t=3.431,P=0.001).会阴侧切组与未侧切组新生儿1 min窒息发生率和5 min窒息发生率比较差异无统计学意义(P=0.886、P=0.261).6名助产士接产的产妇会阴侧切率差异很大,分别为33.0%、83.3%、87.8%、90.6%、90.7%、94.2%,差异有统计学意义(P=0.000),但6组新生儿窒息发生率比较差异无统计学意义.结论 会阴侧切与不侧切之间,母儿结局比较差异无统计学意义,不支持会阴侧切能够缩短产程和预防胎儿窒息.在低危初产妇正常分娩中,会阴侧切的应用在不同的助产士之间差异巨大,提示助产士是影响会阴侧切应用的重要因素.鉴于会阴侧切潜在的危害,应加强指征控制,加强会阴保护与会阴侧切规范化操作培训,提高助产士自身实践水平与判断能力.对于低危初产妇正常分娩不应常规进行会阴侧切.

Case-control Study of Lateral Episiotomy in Spontaneous Vaginal Delivery of Low-Risk Primiparas

Objective To compare different maternal and neonatal outcomes of low risk primiparas with and without episiotomy in spontaneous vaginal delivery.Methods 400 cases of low-risk primiparas with head position,singleton and normal laboring were divided into episiotomy group and non-episiotomy group with case-control study.Maternal and neonatal outcomes were observed.Rate of episiotomy among different midwives also analyzed.Results There was no statistical difference of age,pregnant week,labor process,Apgar score...