149例疑似巨大儿经阴道分娩产妇会阴侧切的影响因素分析  

Analysis of factors influencing lateral episiotomy in 149 women with suspected macrosomia

作　　者：顾传露 郭晨燕[1] 吴刘鑫 孙丽洲[1] 许叶涛 GU Chuanlu;GUO Chenyan;WU Liuxin;SUN Lizhou;XU Yetao(Department of Obstetrics,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院产科,江苏南京210029

出　　处：《南京医科大学学报（自然科学版）》2024年第9期1232-1237,共6页Journal of Nanjing Medical University(Natural Sciences)

基　　金：国家自然科学基金(82371696)。

摘　　要：目的:探讨疑似巨大儿产妇经阴道分娩伴会阴侧切的影响因素。方法:回顾性分析2022年1—7月于南京医科大学第一附属医院产科分娩的149例疑似巨大儿产妇的临床资料,根据是否行会阴侧切,将产妇分为会阴侧切组和自然裂伤组。分析疑似巨大儿产妇经阴道分娩的危险因素。结果:149例疑似巨大儿产妇中,40例(26.85%)行会阴侧切分娩,109例(73.15%)阴道分娩伴自然裂伤,其中93例为Ⅰ度裂伤,16例为Ⅱ度裂伤。会阴侧切组中初产妇、助产士工作年限<5年占比高于裂伤组(P<0.001,P=0.021);会阴侧切组中第2产程<47 min的比例显著高于会阴裂伤组(87.5%vs.39.4%,P<0.001)。此外,自然裂伤组羊水性质(清+Ⅰ度)比例显著高于会阴侧切组(87.2%vs.72.5%,P=0.034),而会阴侧切组产后出血率显著低于自然裂伤组(P=0.010)。初产妇、助产士工作年限<5年是疑似巨大儿产妇会阴侧切的独立危险因素(OR=2.708,P=0.021)。结论:初产妇、助产士工作年限<5年时,产妇疑似巨大儿经阴道分娩伴会阴侧切的发生率增高;同时,侧切组产后出血率显著降低。Objective:To explore the factors influencing lateral episiotomy in vaginal deliveries of suspected macrosomia.Methods:The clinical data of 149 pregnant women with suspected macrosomia who delivered at the Obstetrics Department of the First Affiliated Hospital of Nanjing Medical University from January to July 2022 were analyzed retrospectively.According to whether the perineum was cut laterally during vaginal delivery,the perineum was divided into two groups:the episiotomy group and the natural laceration group.Risk factors for vaginal delivery in pregnant women with suspected macrosomia were analyzed.Results:Among 149 pregnant women with suspected macrosomia,lateral episiotomy was performed in 40 cases(26.85%),while 109 cases(73.15%)had vaginal deliveries accompanied by natural laceration,including 93 cases of GradeⅠlaceration and 16 cases of GradeⅡlaceration.The proportion of primipara and midwives with less than 5 years of experience was higher in the episiotomy group compared to the laceration group(P<0.001,P=0.021);the proportion of the second stage of labor less than 47 min in the episiotomy group was significantly higher than that in the natural laceration group(87.5%vs.39.4%,P<0.001).In addition,the proportion of amniotic fluid properties(clear+Ⅰdegree)in the natural laceration group was significantly higher than that in the episiotomy group(87.2%vs.72.5%,P=0.034),while the rate of postpartum hemorrhage was significantly lower than that in natural laceration group(P=0.010).Primipara and midwives with less than 5 years of experience were independent risk factors for episiotomy in suspected macrosomia(OR=2.708,P=0.021).Conclusion:The incidence of lateral episiotomy in vaginal delivery of suspected macrosomia increases in primipara and midwives with less than 5 years of experience,at the same time,the rate of postpartum hemorrhage in the lateral episiotomy group is significantly reduced.

关 键 词：疑似巨大儿 阴道分娩 会阴侧切 自然裂伤 影响因素 

分 类 号：R714.3[医药卫生—妇产科学]