足月单胎孕妇产钳阴道分娩发生会阴重度裂伤的影响因素分析  

Analysis of the influencing factors of severe perineal laceration for full-term singleton pregnant women during forceps-assisted vaginal delivery

作　　者：吴英 李菁[1] 姜海利[1] Wu Ying;Li Jing;Jiang Haili(Department of Obstetrics,Beijing Obstetrics and Gynecology Hospital,Capital Medical University,Beijing Maternal and Child Health Care Hospital,Beijing 100026,China)

机构地区：[1]首都医科大学附属北京妇产医院/北京妇幼保健院围产医学部,100026

出　　处：《北京医学》2024年第4期268-271,276,共5页Beijing Medical Journal

摘　　要：目的探讨足月单胎孕妇产钳阴道分娩发生会阴重度裂伤的的影响因素。方法选取2012年12月至2023年10月首都医科大学附属北京妇产医院产钳阴道分娩的足月单胎孕妇123例。根据会阴有无重度裂伤分为研究组(41例)和对照组(82例),研究组为产钳阴道分娩发生会阴重度裂伤的足月单胎孕妇,对照组为按照1∶2比例随机选取的同时期产钳分娩无会阴裂伤或会阴I度裂伤的足月单胎孕妇。采用多因素logistic回归分析足月单胎孕妇产钳阴道分娩发生会阴重度裂伤的的影响因素。结果阴道分娩共89622例,其中会阴重度裂伤72例,发生率为0.08%。72例会阴重度裂伤中,产钳助产分娩41例,占56.94%。多因素logistic回归分析结果显示,无会阴侧切(OR=0.028,95%CI:0.003~0.243,P=0.001)、有持续性枕后位(OR=19.737,95%CI:3.862~100.865,P=0.000)和肩难产(OR=12.436,95%CI:2.250~68.730,P=0.004)的足月单胎孕妇产钳阴道分娩更容易发生会阴重度裂伤。结论持续性枕后位、肩难产是足月单胎孕妇产钳阴道分娩发生会阴重度裂伤的高危因素,会阴侧切是保护因素。产科医生及助产士应采取规范的诊疗操作,掌握会阴切开的指征,降低会阴重度裂伤的发生率。Objective To explore the influencing factors of severe perineal laceration for full-term singleton pregnant women during forceps-assisted vaginal delivery.Methods A total of 123 full-term singleton pregnant women with forceps vaginal delivery were selected in Beijing Obstetrics and Gynecology Hospital Affiliated to Capital Medical University from December 2012 to October 2023 were selected,and were divided into the study group(41 cases)and the control group(82 cases)according to the severity of perineal laceration.The study group was consisted of full-term singleton pregnant women with severe perineal laceration during vaginal delivery with forceps,and the control group was full-term singleton pregnant women without perineal laceration or I-degree perineal laceration during delivery with forceps at the same time according to the ratio of 1:2.The influencing factors of severe perineal laceration caused by forceps vaginal delivery in full-term singleton pregnant women was analyzed by multivariate logistic regression.Results There were 89622 cases of vaginal delivery,including 72 cases of severe perineal laceration,the incidence rate was 0.08%.Among the 72 cases of severe perineal laceration,41 cases were delivered by forceps assistance,accounting for 56.94%.Multivariate logistic regression analysis showed that the full-term singleton pregnant women with forceps without perineal lateral episiotomy(OR=0.028,95%CI:0.003-0.243,P=0.001),persistent occipito-posterior position(OR=19.737,95%CI:3.862-100.865,P=0.000)and shoulder dystocia(OR=12.436,95%CI:2.250-68.730,P=0.004)were more likely to have severe perineal laceration.Conclusions The persistent occipito-posterior position and shoulder dystocia are high-risk factors for severe perineal laceration caused by forceps vaginal delivery in full-term singleton pregnant women,and perineal lateral episiotomy is the protective factor.Obstetricians and midwives should adopt standardized manipulate of treatment,master the indications of perineotomy,and reduce the incidence of sev

关 键 词：会阴重度裂伤 产钳 足月单胎 阴道分娩 持续性枕后位 肩难产 会阴侧切 

分 类 号：R714.3[医药卫生—妇产科学]