9200例阴道分娩产妇会阴切开状况的调查分析

目的 探讨阴道分娩产妇会阴侧切状况,分析影响会阴侧切的因素,为控制经阴道分娩会阴侧切率提供参考.方法 选取成都市妇女儿童中心医院实业街院区房妇产科2014年1月至2016年12月间经阴道分娩的产妇9 200例,统计产妇会阴侧切率及裂伤程度,分析影响会阴侧切的相关因素.结果 9 200例产妇会阴侧切率为31.40％ (2 889/9 200),会阴正中切率为5.00％ (460/9 200),会阴裂伤为52.95％ (4 871/9 200),裂伤中以Ⅰ度为主,占46.50％,其次为Ⅱ度裂伤,占6.45％,未发生会阴Ⅲ度及Ⅳ度裂伤.单因素分析结果显示妊娠合并症、胎吸产钳助产、第二产程延长、会阴条件差、羊水污染、胎儿体重＞3 5009、胎儿宫内窘迫与会阴侧切显著相关(r值分别为0.628、0.637、0.612、0.827、0.704、0.742、0.704,均P＜0.05),而初产妇与会阴侧切无显著相关性(r=0.217,均P＞0.05).多元Logistic回归分析后发现妊娠合并症、胎吸产钳助产、第二产程延长、会阴条件差、羊水污染、胎儿体重＞3 500g、胎儿宫内窘迫均是会阴侧切的危险因素(OR值分别为1.842、1.913、1.774、1.973、1.883、1.880、1.958,均P＜0.05).结论 多种因素影响产妇经阴道分娩会阴侧切,产科应综合考虑,以控制会阴侧切,改善产妇产后生活质量.

Investigation and analysis of perineum incision in 9 200 women with vaginal delivery

Objective To analyze episiotomy in women with vaginal delivery and its influencing factors,so as to provide reference for episiotomy rate control in vaginal delivery.Methods Between January 2014 and December 2016 totally 9 200 cases of vaginal delivery were selected from the obstetrics department of Industrial Street Branch of Women and Children Central Hospital of Chengdu.Episiotomy rate and laceration degree of the cases were recorded to analyze the related influencing factors of episiotomy.Results Episiotomy rate was 31.40％ (2 889/9 200),center perineum cut rate was 5.00％ (460/9 200),and perineal laceration rate was 52.95％ (4 871/9 200) in 9 200 cases.Laceration of Ⅰ degree occupied most,accounting for 46.50％,followed by Ⅱ degree,accounting for 6.45 ％.No laceration of Ⅲ or Ⅳ degree was found.Single factor analysis results showed that pregnancy complications,fetal forceps midwifery,prolonged second labor,poor perineum condition,amniotic fluid contamination,fetal weight ＞ 3 500g and fetal intrauterine distress were associated with episiotomy significantly (r value was 0.628,0.637,0.612,0.827,0.704,0.742 and 0.704,respectively,all P ＜ 0.05),while primipara had no significant correlation with episiotomy (r =0.217,P ＞ 0.05).Multiple Logistic regression analysis found that pregnancy complications,fetal forceps midwifery,prolonged second labor,poor conditions of perineum,amniotic fluid contamination,fetal weight ＞ 3 500g and fetal intrauterine distress were risk factors for episiotomy (OR value was 1.842,1.913,1.774,1.973,1.883,1.880 and 1.958,respectively,all P ＜ 0.05).Conclusion Many factors affect episiotomy in maternal vaginal delivery.Obstetrician should consider comprehensively to control episiotomy and to improve maternal quality of life after delivery.