文档介绍:会阴撕裂缝合Repair of Perineal Lacerations
山东大学附属省立医院妇产科
山东省妇产医院
王谢桐
是否进行会阴预防性切开
误区
我们的初产妇会阴切开率达90%以上
理由:
预防会阴严重裂伤
预防产后盆底肌肉松弛
防止新生儿颅内出血
会阴切开刀口整齐,容易缝合
没有已发表的研究可证明这些假设的正确性
现有的研究发现会阴切开术
增加三度或四度裂伤的风险
会阴水肿
产后排尿困难(需要导尿和尿道感染率增加)
持续的会阴部疼痛、影响产妇活动及哺乳
性交困难或疼痛
不能防止盆底损害以及将来的尿失禁和排便失禁
产后感染的风险增加
再次妊娠后的会阴撕裂
增加母体花费和延长恢复时间。
美国的会阴切开
1900: virtually non-existent
1980: 64% of vaginal births
2000: 33% of vaginal births
Episiotomies per 100 Hospital Vaginal Deliveries
Rectal Trauma Rates (3rd /4th degree tears) - USA
ACOG Practice Bulletin
Level A
Restricted use of episiotomy is preferable to routine use of episiotomy.
Median episiotomy is associated with higher rates of injury to the anal sphincter and rectum than is mediolateral episiotomy.
Level B
Mediolateral episiotomy may be preferable to median episiotomy in selected cases.
Routine episiotomy does not prevent pelvic floor damage leading to incontinence.
ACOG Practice Bulletin. Episiotomy. Clinical Management Guidelines for Obstetrician-Gynecologists. Number 71, April Gynecol. 2006 Apr;107(4):957-62.