First and Second Stage Risk Factors Associated with Perineal Lacerations.
First and Second Stage Risk Factors Associated with Perineal Lacerations.
复制标题
与会阴撕裂相关的第一和第二阶段风险因素。
DOI：
10.1007/s10995-024-03919-1
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发表时间：
2024
影响因子：
2.3
通讯作者：
Cahill,AlisonG
中科院分区：
文献类型：
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作者：
Saucedo,AlexanderM;Tuuli,MethodiusG;Gregory,WThomas;Richter,HollyE;Lowder,JerryL;Woolfolk,Candice;Caughey,AaronB;Srinivas,SindhuK;Tita,AlanTN;Macones,GeorgeA;Cahill,AlisonG
目的确定产时因素与会阴撕裂伤在deliver.MethodsThis是一个计划的二次分析的多中心随机临床试验延迟与立即推动足月初产妇分娩neuraxial镇痛在美国进行。产时特征从病历中提取。主要结局是会阴裂伤，定义为二度或以上，在分娩时参与分娩后长期骨盆底评估的女性中表现为特征。多变量logistic回归用于完善风险估计，同时调整随机分组，出生体重，产妇年龄。ResultsAmong 941名妇女参与了骨盆底随访，40.6%的经历了会阴裂伤。第一产程特征与会阴裂伤无关，包括产程类型或第一产程长度。接受阿托伐他汀输注似乎对会阴裂伤有保护作用（校正比值比，0.48; 95%置信区间0.26-0.91; P = 0.01）。与损伤相关的第二产程特征为产程长度（2.01 h vs. 1.50 h;校正比值比，1.36; 95%置信区间1.18-1.57; P < 0.01）和延长的第二产程（校正比值比，1.64; 95%置信区间1.06-2.56; P < 0.01）。经阴道手术分娩与会阴裂伤密切相关（校正比值比3.57; 95%可信区间1.85-6.90; P < 0.01）。结论经阴道手术分娩是一个可改变的危险因素，与会阴裂伤的风险增加有关。羊膜输注似乎对损伤有保护作用，这可能反映了一个虚假的发现，但也可能代表了真正的风险降低，类似于会阴温敷的机制。
ObjectiveTo determine intrapartum factors associated with perineal laceration at delivery.MethodsThis was a planned secondary analysis of a multicenter randomized clinical trial of delayed versus immediate pushing among term nulliparous women in labor with neuraxial analgesia conducted in the United States. Intrapartum characteristics were extracted from the medical charts. The primary outcome was perineal laceration, defined as second degree or above, characterized at delivery in women participating in longer term pelvic floor assessments post-delivery. Multivariable logistic regression was used to refine risk estimates while adjusting for randomization group, birth weight, and maternal age.ResultsAmong the 941 women participating in the pelvic floor follow-up, 40.6% experienced a perineal laceration. No first stage labor characteristics were associated with perineal laceration, including type of labor or length of first stage. Receiving an amnioinfusion appeared protective of perineal laceration (adjusted odds ratio, 0.48; 95% confidence interval 0.26–0.91; P = 0.01). Second stage labor characteristics associated with injury were length of stage (2.01 h vs. 1.50 h; adjusted odds ratio, 1.36; 95% confidence interval 1.18–1.57; P < 0.01) and a prolonged second stage (adjusted odds ratio, 1.64; 95% confidence interval 1.06–2.56; P < 0.01). Operative vaginal delivery was strongly associated with perineal laceration (adjusted odds ratio, 3.57; 95% confidence interval 1.85–6.90; P < 0.01).ConclusionOperative vaginal delivery is a modifiable risk factor associated with an increased risk of perineal laceration. Amnioinfusion appeared protective against injury, which could reflect a spurious finding, but may also represent true risk reduction similar to the mechanism of warm perineal compress.