客观评估会阴裂伤的前瞻性研究  

A prospective study on objective assessment of perineal lacerations

作　　者：冯英 谢旭 杜慧[1] 李明蔚 郑勤田 Feng Ying;Xie Xu;Du Hui;Li Mingwei;Zheng Qintian(Department of Obstetrics and Gynecology,the Fourth Hospital of Shijiazhuang(Hebei Provincial Center for Obstetric Quality Control,Hebei Provincial Key Laboratory of Maternal-Fetal Medicine),Shijiazhuang050000,China;Department of Obstetrics and Gynecology,University of Arizona College of Medicine,Phoenix85254,USA)

机构地区：[1]河北省石家庄市第四医院妇产科(河北省产科质量管理与控制中心,河北省母胎医学重点实验室),石家庄050000 [2]美国亚利桑那大学医学院妇产科,凤凰城85254

出　　处：《中华围产医学杂志》2024年第11期885-892,共8页Chinese Journal of Perinatal Medicine

摘　　要：目的系统观察产时会阴裂伤的发生部位及严重程度,并探讨会阴体皮肤裂伤长度(perineal skin laceration length,PSLL)和会阴体裂伤深度(perineal laceration depth,PLD)与会阴体裂伤分度之间的关系。方法本研究为前瞻性研究。招募2023年3月至7月在石家庄市第四医院计划阴道分娩的足月单胎头位孕妇。在第二产程用力前测量会阴体长度(perineal body length,PBL),分娩后测量并记录所有产道裂伤的位置、PSLL及PLD,必要时使用放大镜鉴别各层组织并拍照。采用t检验、秩和检验、χ2检验或Fisher精确概率法比较初产妇与经产妇基本情况、产道裂伤等情况。采用受试者工作特征曲线分析PSLL、PLD及PSLL/PBL比值的灵敏度和特异度等。结果研究期间,共纳入200例产妇,其中189例阴道分娩,包括初产妇173例、经产妇16例;11例中转剖宫产,包括初产妇10例、经产妇1例。173例阴道分娩的初产妇中,33例(19.1%)会阴侧切,余140例(80.9%)会阴体裂伤,其中9例会阴体裂伤合并阴道壁裂伤、20例合并阴唇裂伤、4例合并阴蒂和尿道口周围裂伤。140例会阴体裂伤的初产妇中,32例(22.9%)发生Ⅰ度会阴体裂伤,108例(77.1%)发生Ⅱ度会阴体裂伤。16例阴道分娩的经产妇中,2例产道完整无裂伤,14例发生会阴体裂伤(包括8例Ⅰ度裂伤、6例Ⅱ度裂伤),无会阴侧切或阴道助产。初产妇会阴侧切率及Ⅱ度会阴体裂伤发生率均高于经产妇[19.1%(33/173)与0/16、77.1%(108/173)与6/14,Fisher精确概率法,P值均<0.05]。Ⅰ度会阴体裂伤初产妇的PSLL、PLD、PSLL/PBL比值均显著低于Ⅱ度会阴体裂伤初产妇[分别为0.0 mm(0.0~10.0 mm)与30.0 mm(25.5~40.0 mm)、5.0 mm(1.5~10.0 mm)与14.0 mm(10.0~15.0 mm)、0.0 mm(0.0~21.1 mm)与63.6 mm(50.0~77.3 mm),Z值分别为-8.04、-6.46及-7.75,P值均<0.05]。PSLL、PLD、PSLL/PBL比值用于区分Ⅰ度和Ⅱ度会阴体裂伤的最佳界值分别为15 mm、9 mm、33.33%,曲线下面积(area underObjectiveTo systematically observe the location and severity of perineal lacerations during childbirth and explore the relationship between the length/depth and the degrees of perineal lacerations.MethodsThis prospective study recruited full-term singleton cephalic pregnant women planning vaginal delivery at the Fourth Hospital of Shijiazhuang from March 2023 to July 2023.Before the second stage of labor,the perineal body length(PBL)was measured.After delivery,the locations of all birth canal lacerations,the perineal skin lacerations length(PSLL),and the perineal lacerations depth(PLD)were measured and recorded.A magnifying glass was used to identify the layers of the skin and photographs were taken if necessary.Statistical methods such as t-test,rank-sum test,and Chi-square test(or Fisher's exact test)were used to compare the basic conditions and birth canal lacerations between primiparous and multiparous women.The receiver operating characteristic(ROC)curve was used to analyze the sensitivity and specificity of PSLL,PLD,and the PSLL/PBL ratio.ResultsDuring the study period,200 women were included,of which 189 had vaginal deliveries(173 primiparous and 16 multiparous)and 11 had emergency cesarean sections(10 primiparous and one multiparous).Among the 173 primiparous women with vaginal deliveries,33(19.1%)underwent episiotomy,and the other 140(80.9%)had perineal lacerations.Among these cases of perineal lacerations,nine were complicated by vaginal wall lacerations,20 by labial lacerations,and four by clitoral and urethral lacerations.There were 32(22.9%)primiparous women with first-degree perineal lacerations and 108(77.1%)with second-degree perineal lacerations.Among the 16 multiparous women who delivered vaginally,two had intact birth canals without lacerations,and 14 had perineal lacerations(eight with first-degree and six with second-degree perineal lacerations).Besides,none of them underwent episiotomy or assisted vaginal delivery.The rates of episiotomy and second-degree perineal lacerations were higher in

关 键 词：阴道分娩 会阴裂伤 会阴体长度 前瞻性研究 

分 类 号：R714.3[医药卫生—妇产科学]