分娩时会阴严重裂伤危险因素的配对病例对照研究  

A matched case-control study on risk factors of women’s severe perineal tears during labor

作　　者：尹秀雪 杨婷婷 王晓娇 毛丽萍[1] 高华 顾春怡[1] YIN Xiu Xue;YANG Ting Ting;WANG Xiao Jiao;MAO Li Ping;GAO Hua;GU Chun Yi(Obstetrics and Gynecology Hospital,Fudan University,Shanghai 200011,China;School of Nursing,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属妇产科医院,上海200011 [2]复旦大学护理学院,上海200032

出　　处：《中国妇幼卫生杂志》2023年第6期54-61,共8页Chinese Journal of Women and Children Health

基　　金：国家自然科学基金资助项目(72004029);上海市卫生健康委员会卫生行业临床研究专项(202040097);2022年复旦-复星护理科研基金面上项目(FNF202260)。

摘　　要：目的探讨分娩时会阴严重裂伤发生的危险因素,为预防和控制会阴严重裂伤的发生提供科学依据,以持续提高助产技术质量,促进妇女产后康复。方法采用配对病例对照研究方法,选取2016年1月—2022年4月在上海市某三级甲等妇产专科医院经阴道分娩且出院诊断为会阴严重裂伤(Ⅲ、Ⅳ度)的产妇纳入病例组,共16例;同期按照年龄(±5岁)、分娩日期(±42 d)以1∶4配对的原则,选取64例未发生会阴严重裂伤(即会阴裂伤程度为0、Ⅰ或Ⅱ度)的产妇作为对照组。对分娩时会阴严重裂伤相关因素进行单因素分析和多因素条件logistic回归分析。结果病例组与对照组产妇的年龄、身高、分娩孕周及受教育程度均衡可比(均P>0.05)。单因素分析结果显示,病例组与对照组在是否为初产妇、有无宫颈手术史、入室测量腹围、孕期增重、孕前体质质量、第二产程时长以及是否为肩难产方面的比较,差异均有统计学意义(均P<0.05)。多因素条件logistic回归分析结果显示,初产妇(P=0.043,OR=43.212,95%CI:1.120~1667.865)、宫颈手术史(P=0.023,OR=25.194,95%CI:1.548~410.123)、孕期增重过度(P=0.021,OR=15.020,95%CI:1.518~148.614)和孕前肥胖(P=0.030,OR=869.382,95%CI:1.900~397823.015)是分娩时会阴严重裂伤发生的独立危险因素。结论初产妇、有宫颈手术史、孕期增重过度、孕前肥胖的产妇分娩时发生会阴严重裂伤的风险较高。助产医疗机构应重视开展规范的孕前保健和孕期体重管理,尤其针对初产妇人群,应注重实施正确的产程管理,以预防分娩时会阴严重裂伤的发生。Objective To investigate risk factors of severe perineal tears,so as to provide scientific evidence for preventing severe perineal tears,improve the quality of midwifery techniques and promote postpartum recovery.Methods From January 2016 to April 2022,16 women with severe perineal tears(degreeⅲand iv)who delivered vaginally in a grade A tertiary obstetrical and gynecological hospital were recruited as case group.At the same time,64 parturients without severe perineal tears(0,ⅰ,ⅱdegrees)were recruited as control group according to age(±5 years)and delivery date(±42 days)with a 1:4 matched case-control study design.The risk factors of severe perineal tears during delivery were analyzed by univariate and multivariate conditional logistic regression analysis.Results The maternal age,height,gestational weeks at delivery,and educational background were comparable between 2 groups(all P>0.05).Univariate analysis indicated that there were statistically significant differences between 2 groups in terms of being primipara,history of cervical surgery,abdominal circumference,weight gain during pregnancy,pre-pregnancy body mass index,duration of the second stage of labor,and being shoulder dystocia(all P<0.05).Logistic regression analysis showed primipara(P=0.043,OR=43.212,95%CI:1.120−1667.865),history of cervical surgery(P=0.023,OR=25.194,95%CI:1.548−410.123),excessive weight gain during pregnancy(P=0.021,OR=15.020,95%CI:1.518−148.614)and pre-pregnancy obesity(P=0.030,OR=869.382,95%CI:1.900−397823.015)were independent risk factors associated with severe perineal tears in vaginal delivery.Conclusion Primipara,history of cervical surgery,excessive weight gain during pregnancy and pre-pregnancy obesity have higher risk of severe perineal tears during childbirth.Maternity settings should emphasize on providing standardized prepregnancy care and weight management during pregnancy,especially for primiparas,and implement correct labor process management to prevent the occurrence of severe perineal tears during chil

关 键 词：阴道分娩 会阴严重裂伤 危险因素 病例对照研究 

分 类 号：R714.3[医药卫生—妇产科学]