摘要

CONTEXT:Episiotomy at the time of vaginal birth is common. Practice patterns vary widely, as do professional opinions about maternal risks and benefits associated with routine use.
OBJECTIVE:To systematically review the best evidence available about maternal outcomes of routine vs restrictive use of episiotomy.
EVIDENCE ACQUISITION:We searched MEDLINE, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Collaboration resources and performed a hand search for English-language articles from 1950 to 2004. We included randomized controlled trials of routine episiotomy or type of episiotomy that assessed outcomes in the first 3 postpartum months, along with trials and prospective studies that assessed longer-term outcomes. Twenty-six of 986 screened articles provided relevant data. We entered data into abstraction forms and conducted a second review for accuracy. Each article was also scored for research quality.
EVIDENCE SYNTHESIS:Fair to good evidence from clinical trials suggests that immediate maternal outcomes of routine episiotomy, including severity of perineal laceration, pain, and pain medication use, are not better than those with restrictive use. Evidence is insufficient to provide guidance on choice of midline vs mediolateral episiotomy. Evidence regarding long-term sequelae is fair to poor. Incontinence and pelvic floor outcomes have not been followed up into the age range in which women are most likely to have sequelae. With this caveat, relevant studies are consistent in demonstrating no benefit from episiotomy for prevention of fecal and urinary incontinence or pelvic floor relaxation. Likewise, no evidence suggests that episiotomy reduces impaired sexual function--pain with intercourse was more common among women with episiotomy.
CONCLUSIONS:Evidence does not support maternal benefits traditionally ascribed to routine episiotomy. In fact, outcomes with episiotomy can be considered worse since some proportion of women who would have had lesser injury instead had a surgical incision.

译文

背景: 阴道分娩时会阴切开很常见。实践模式差异很大,关于常规使用的产妇风险和益处的专业意见也差异很大。
目的: 系统回顾常规与限制性会阴切开术产妇结局的最佳证据。
证据获取: 我们搜索了 MEDLINE 、护理累积索引和联合健康文献,以及 Cochrane 协作资源,并对 1950年至 2004年的英语文章进行了手工搜索。我们纳入了评估产后前 3 个月结果的常规会阴切开术或会阴切开术类型的随机对照试验,以及评估长期结果的试验和前瞻性研究。986 篇筛选的文章中有 26 篇提供了相关数据。我们将数据输入抽象形式,并对准确性进行了第二次审查。每篇文章也对研究质量进行评分。
证据综合: 来自临床试验的相当好的证据表明,常规会阴切开术的直接母体结果,包括会阴裂伤的严重程度、疼痛和止痛药的使用, 并不比那些限制使用的好。证据不足以提供中线与内侧会阴切开选择的指导。关于长期后遗症的证据对穷人来说是公平的。尿失禁和盆底结果没有被追踪到女性最有可能有后遗症的年龄范围。有了这一警告,相关研究一致表明会阴切开术对预防大便失禁和尿失禁或盆底松弛没有益处。同样,没有证据表明会阴切开可以减少性功能受损 -- 性交疼痛在会阴切开的女性中更常见。
结论: 证据不支持传统上归因于常规会阴切开术的母亲益处。事实上,会阴切开术的结果可以被认为是更糟糕的,因为一些受伤较小的女性会有手术切口。

episiotomy

妇产 分娩助产 手术操作
概述  :  

产道是胎儿分娩的必经之路,产道又分骨产道和软产道,在阴道与肛门之间的软组织称会阴,会阴体则是阴道口到肛门之间的软组织,它们都是软产道的一部分。会阴切开术是产科最为常用的临床操作之一。2000年,大约33%的阴道分娩产妇行会阴切开术。传统观点认为会阴切开术旨在促进第二产程的完成进而改善母儿妊娠结局。认为施行会阴切开术可以降低母体会阴损伤、以后的盆底功能障碍以及脱垂、尿失禁、大便失禁以及性生活障碍的风险。对胎儿潜在的好处包括由于自然分娩进程加快或阴道助产而导致的第二产程缩短。虽然研究数据有限,但

episiotomy   英 [ɪˌpiːsiˈɒtəmi]  美 [ɪˌpiːsiˈɑːtəmi]

释    义   n. [妇产]会阴切开术

例    句   The effects of mediolateral episiotomy on pelvic floor function after vaginal delivery. 会阴侧切术对阴道分娩后骨盆底组织功能的影响。

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