会阴切开术及其并发症的研究进展
Progress in the Study of Episiotomy and Its Complications
DOI: 10.12677/MD.2023.133048, PDF,   
作者: 高 李, 贾 静:延安大学医学院,陕西 延安;任永变:延安大学附属医院产科,陕西 延安
关键词: 会阴切开术并发症研究进展Perineotomy Complications Research Progress
摘要: 分娩总是给女性的身体带来创伤性压力。为了减少分娩时的会阴创伤,产科医生会使用会阴切开术。尽管对其使用存在争议,但会阴切开术仍然是一种常见的做法。权衡利弊,科学文献支持选择性使用会阴切开术。随着世界范围内使用会阴切开术降低的趋势,已经提出了几种技术来实现这一目标。然而,仍需要进一步的研究来证明它们的功效。会阴切开术是一种阴道和会阴的手术切口,有时用于防止因撕裂造成的严重会阴损伤并促进婴儿的出生。但在产妇围产期会阴切口愈合的不同阶段可能出现各种各样的并发症,且会给产妇带来痛苦并降低其产后生活质量,因此,本文对会阴切开术及其术后并发症进行探讨,希望能为临床上会阴切开术后如何护理提供参考。
Abstract: Childbirth always puts traumatic stress on a woman’s body. To reduce perineal trauma during childbirth, obstetricians use an episiotomy. Despite controversy over its use, episiotomy remains a common practice. Weighing the pros and cons, the scientific literature supports the selective use of episiotomy. With the worldwide trend of decreasing use of episiotomy, several techniques have been proposed to achieve this. However, further research is needed to prove their efficacy. An epi-siotomy is a surgical incision of the vagina and perineum that is sometimes used to prevent severe perineal damage from a tear and to promote the birth of a baby. However, various complications may occur in different stages of perinatal perineal incision healing, which will bring pain to the mothers and reduce their postpartum quality of life. Therefore, this paper discusses the perineot-omy and its postoperative complications, hoping to provide reference for clinical care after perineotomy.
文章引用:高李, 任永变, 贾静. 会阴切开术及其并发症的研究进展[J]. 医学诊断, 2023, 13(3): 312-319. https://doi.org/10.12677/MD.2023.133048

参考文献

[1] Jiang, H., Qian, X., Carroli, G. and Garner, P. (2017) Selective versus Routine Use of Episiotomy for Vaginal Birth. Cochrane Database of Systematic Reviews, 2, CD000081. [Google Scholar] [CrossRef
[2] Schmidt, P.C. and Fenner, D.E. (2022) Repair of Episiotomy and Obstetrical Perineal Lacerations (First-Fourth). American Journal of Obstet-rics and Gynecology.
[3] Barjon, K. and Mahdy, H. (2022) Episiotomy. StatPearls, Treasure Island.
[4] Ginath, S., Elyashiv, O., Weiner, E., et al. (2017) The Optimal Angle of the Mediolateral Episiotomy at Crowning of the Head during Labor. International Urogynecology Journal, 28, 1795-1799. [Google Scholar] [CrossRef] [PubMed]
[5] Kalis, V., Laine, K., de Leeuw, J.W., Ismail, K.M. and Tincello, D.G. (2012) Classification of Episiotomy: Towards a Standardisation of Terminology. BJOG: An International Journal of Obstetrics & Gynaecology, 119, 522-526. [Google Scholar] [CrossRef] [PubMed]
[6] Kalis, V., Stepan, J.J., Horak, M., et al. (2008) Definitions of Me-diolateral Episiotomy in Europe. International Journal of Gynecology & Obstetrics, 100, 188-189. [Google Scholar] [CrossRef] [PubMed]
[7] Ye, J., Chen, Y., Yang, H., Chen, Q., Huang, Y., Zhao, J., Tu, L., Liu, M. and Zhang, J. (2021) A Nationwide Cross-Sectional Survey of Episiotomy Practice in China. The Lancet Regional Health—Western Pacific, 19, Article ID: 100345. [Google Scholar] [CrossRef] [PubMed]
[8] Dillon, S.J., Nelson, D.B., Spong, C.Y. and McIntire, D.D. (2021) Forceps and Episiotomy: Do They Go Hand in Hand or Should They Go Their Separate Ways? American Journal of Obstetrics & Gynecology MFM, 3, Article ID: 100370. [Google Scholar] [CrossRef] [PubMed]
[9] Midwives Branch of Maternal and Child Health Care of China Associ-ation (2019) Guideline of Repairing Techniques and Material Selection in Episiotomy and Perineal Tears. Chinese Nursing Management, 19, 453-457.
[10] (2018) ACOG Practice Bulletin No. 198: Prevention and Management of Obstetric Lacerations at Vaginal Delivery. Obstetrics and Gynecology, 132, e87-e102. [Google Scholar] [CrossRef
[11] Albuquerque, R.C., Pereira, G.M.V., Luz, A.G., Nóbrega, M.A., Lajos, G.J. and Brito, L.G.O. (1992) Risk Factors for Mediolateral Episiotomy at a Tertiary Hospital: A Cross-Sectional Study. Revista da Associação Médica Brasileira, 68, 463-469. [Google Scholar] [CrossRef] [PubMed]
[12] Melo, I., Katz, L., Coutinho, I. and Amorim, M.M. (2014) Selective Episiotomy vs. Implementation of a Non Episiotomy Protocol: A Ran-domized Clinical Trial. Reproductive Health, 11, Article No. 66. [Google Scholar] [CrossRef] [PubMed]
[13] Ghulmiyyah, L., Sinno, S., Mirza, F., Finianos, E. and Nassar, A.H. (2022) Episiotomy: History, Present and Future—A Review. The Journal of Maternal-Fetal & Neonatal Medicine, 35, 1386-1391. [Google Scholar] [CrossRef] [PubMed]
[14] Fodstad, K., Laine, K. and Staff, A.C. (2013) Different Episiotomy Techniques, Postpartum Perineal Pain, and Blood Loss: An Observational Study. International Urogynecology Journal, 24, 865-872. [Google Scholar] [CrossRef] [PubMed]
[15] Khan, N.B., Anjum, N., Hoodbhoy, Z. and Khoso, R. (2020) Episiotomy and Its Complications: A Cross Sectional Study in Secondary Care Hospital. Journal of the Pakistan Medical Association, 70, 2036-2038.
[16] East, C.E., Begg, L., Henshall, N.E., Marchant, P.R. and Wallace, K. (2012) Local Cooling for Relieving Pain from Perineal Trauma Sustained during Childbirth. Cochrane Database of Systematic Reviews, 10, CD006304. [Google Scholar] [CrossRef
[17] Chou, D., Abalos, E., Gyte, G.M. and Gülmezoglu, A.M. (2013) Paracetamol/Acetaminophen (Single Administration) for Perineal Pain in the Early Postpartum Period. Cochrane Database of Systematic Reviews, 8, CD008407. [Google Scholar] [CrossRef
[18] Goh, R., Goh, D. and Ellepola, H. (2018) Perineal Tears—A Re-view. Australian Journal of General Practice, 47, 35-38. [Google Scholar] [CrossRef
[19] 沈敏, 郑雅宁, 张竑. 会阴冷敷护带的研制[J]. 护理学报, 2018, 25( 24): 59-60.
[20] Department of Health (2012) Queensland Clinical Guidelines. Maternity and Neonatal Clinical Guidelines: Perineal care. Statewide Maternity and Neonatal Clinical Network, Queensland.
[21] Oberaigner, W., Leitner, H., Oberaigner, K., et al. (2013) Migrants and Obstetrics in Austria—Applying a New Questionnaire Shows Differences in Obstetric Care and Outcome. Wiener klinische Wochenschrift, 125, 34-40. [Google Scholar] [CrossRef] [PubMed]
[22] Berghella, V., Baxter, J.K. and Chauhan, S.P. (2008) Evidence-Based Labor and Delivery Management. American Journal of Obstetrics & Gynecology, 199, 445-454. [Google Scholar] [CrossRef] [PubMed]
[23] Kapoor, D.S., Thakar, R. and Sultan, A.H. (2015) Obstetric anal Sphincter Injuries: Review of Anatomical Factors and Modifiable Second Stage Interventions. International Urogynecology Journal, 26, 1725-1734. [Google Scholar] [CrossRef] [PubMed]
[24] de Castro Monteiro, M.V., Pereira, G.M., Aguiar, R.A., Azevedo, R.L., Correia-Junior, M.D. and Reis, Z.S. (2016) Risk Factors for Severe Obstetric Perineal Lacerations. International Urogynecolo-gy Journal, 27, 61-67. [Google Scholar] [CrossRef] [PubMed]
[25] Mikolajczyk, R.T., Zhang, J., Troendle, J. and Chan, L. (2008) Risk Factors for Birth Canal Lacerations in Primiparous Women. American Journal of Perinatology, 25, 259-264. [Google Scholar] [CrossRef] [PubMed]
[26] Shmueli, A., Gabbay Benziv, R., Hiersch, L., et al. (2017) Episioto-my—Risk Factors and Outcomes. The Journal of Maternal-Fetal & Neonatal Medicine, 30, 251-256. [Google Scholar] [CrossRef] [PubMed]
[27] Gün, İ., Doğan, B. and Özdamar, Ö. (2016) Long-and Short-Term Complications of Episiotomy. Turkish Journal of Obstetrics and Gynecology, 13, 144-148. [Google Scholar] [CrossRef] [PubMed]
[28] Tsumagari, A., Ohara, R., Mayumi, M., et al. (2019) Clinical Characteristics, Treatment Indications and Treatment Algorithm for Post-Partum Hematomas. Journal of Obstetrics and Gynaecology Research, 45, 1127-1133. [Google Scholar] [CrossRef] [PubMed]
[29] Ho, J.J., Pattanittum, P., Japaraj, R.P., Turner, T., et al. (2010) Influence of Train-ing in the Use and Generation of Evidence on Episiotomy Practice and Perineal Trauma. International Journal of Gynecology & Obstetrics, 111, 13-18. [Google Scholar] [CrossRef] [PubMed]
[30] Mulder, F.E., Schoffelmeer, M.A., Hakvoort, R.A., et al. (2012) Risk Factors for Postpartum Urinary Retention: A Systematic Review and Meta-Analysis. BJOG: An International Journal of Ob-stetrics & Gynaecology, 119, 1440-1446. [Google Scholar] [CrossRef] [PubMed]
[31] Baheti, V.H., Wagaskar, V.G. and Patwardhan, S.K. (2015) Missed Iatrogenic Bladder Rupture following Normal Vaginal Delivery. Journal of Clinical and Diagnostic Research, 9, PD01-PD02. [Google Scholar] [CrossRef
[32] Beckmann, M.M. and Stock, O.M. (2013) Antenatal Perineal Mas-sage for Reducing Perineal Trauma. Cochrane Database of Systematic Reviews, 4, CD005123. [Google Scholar] [CrossRef
[33] Kamel, A. and Khaled, M. (2014) Episiotomy and Obstetric Peri-neal Wound Dehiscence: Beyond Soreness. Journal of Obstetrics and Gynaecology, 34, 215-217. [Google Scholar] [CrossRef] [PubMed]
[34] Bonet, M., Ota, E., Chibueze, C.E. and Oladapo, O.T. (2017) Antibi-otic Prophylaxis for Episiotomy Repair following Vaginal Birth. Cochrane Database of Systematic Reviews, 11, CD012136. [Google Scholar] [CrossRef
[35] Tharpe, N. (2008) Postpregnancy Genital Tract and Wound In-fections. Journal of Midwifery & Women’s Health, 53, 236-246. [Google Scholar] [CrossRef] [PubMed]
[36] Gravett, C.A., Gravett, M.G., Martin, E.T., Bernson, J.D., Khan, S., et al. (2012) Serious and Life-Threatening Pregnancy-Related Infec-tions: Opportunities to Reduce the Global Burden. PLOS Medicine, 9, e1001324. [Google Scholar] [CrossRef] [PubMed]
[37] 雷芳芳,董一娜,宋启煦,杨艳.会阴切开术及其并发症的研究进展[J].中国性科学,2022,31(05):121-124.
[38] Fernando, R.J., Sultan, A.H., Freeman, R.M., Williams, A.A. and Adams, E.J. (2015) The Management of Third- and Fourth-Degree Perineal Tears. Guideline No. 29. Royal College of Obstetricians and Gynaecologists, London.
[39] Fodstad, K., Staff, A.C. and Laine, K. (2016) Sexual Activity and Dyspareunia the First Year Postpartum in Relation to Degree of Perineal Trauma. International Urogynecology Journal, 27, 1513-1523. [Google Scholar] [CrossRef] [PubMed]
[40] Sundquist, J.C. (2012) Long-Term Outcome after Obstetric Injury: A Retrospective Study. Acta Obstetricia et Gynecologica Scandinavica, 91, 715-718. [Google Scholar] [CrossRef] [PubMed]
[41] Živković, K., Živković, N., Župić, T., Hodžić, D., Mandić, V. and Orešković, S. (2016) Effect of Delivery and Episiotomy on the Emergence of Urinary Incontinence in Women: Review of Liter-ature. Acta Clinica Croatica, 55, 615-624.
[42] Fornell, E.U., Matthiesen, L., Sjödahl, R. and Berg, G. (2005) Obstetric anal Sphincter Injury Ten Years after: Subjective and Objective Long Term Effects. BJOG: An International Journal of Obstetrics & Gynaecology, 112, 312-316. [Google Scholar] [CrossRef] [PubMed]
[43] Shanmuga Jayanthan, S., Shashikala, G. and Arathi, N. (2019) Perineal Scar Endometriosis. Indian Journal of Radiology and Imaging, 29, 457-461. [Google Scholar] [CrossRef
[44] Botezatu, R., Turcu-Duminica, A., Ciobanu, A.M., Gica, N., Peltecu, G. and Panaitescu, A.M. (2021) Episiotomy Scar Endometriosis. Case Presentation. Maedica, 16, 713-716. [Google Scholar] [CrossRef
[45] Xu, S., Wang, W. and Sun, L.P. (2020) Comparison of Clear Cell Carcinoma and Benign Endometriosis in Episiotomy Scar: Two Cases Report and Literature Review. BMC Women’s Health, 20, Article No. 11. [Google Scholar] [CrossRef] [PubMed]
[46] Zilberman, A., Sheiner, E., Barrett, O., Hamou, B. and Silberstein, T. (2018) Once Episiotomy, Always Episiotomy? Archives of Gynecology and Obstetrics, 298, 121-124. [Google Scholar] [CrossRef] [PubMed]
[47] Murphy, D., Strachan, B., Bahl, R. and the Royal College of Obstetri-cians and Gynaecologists (2020) Assisted Vaginal Birth: Green-Top Guideline No. 26. BJOG: An International Journal of Ob-stetrics & Gynaecology, 127, e70-e112. [Google Scholar] [CrossRef] [PubMed]
[48] Gyhagen, M., Ellström Engh, M., Husslein, H., et al. (2021) Temporal Trends in Obstetric Anal Sphincter Injury from the First Vaginal Delivery in Austria, Canada, Norway, and Sweden. Acta Ob-stetricia et Gynecologica Scandinavica, 100, 1969-1976. [Google Scholar] [CrossRef] [PubMed]
[49] Antonakou, A., Papout-sis, D., Henderson, K., Qadri, Z. and Tapp, A. (2017) The Incidence of and Risk Factors for a Repeat Obstetric Anal Sphincter Injury (OASIS) in the Vaginal Birth Subsequent to a First Episode of OASIS: A Hospital-Based Cohort Study. Archives of Gynecology and Obstetrics, 295, 1201-1209. [Google Scholar] [CrossRef] [PubMed]
[50] World Health Organization (2018) WHO Recommendations: Intrapartum Care for a Positive Childbirth Experience. Geneva, 150-155.
[51] American College of Obstetricians-Gynecologists (2006) ACOG Practice Bulletin. Episiotomy. Clinical Management Guidelines for Obstetrician-Gynecologists. Number 71, April 2006. Obstetrics & Gynecology, 107, 957-962.
[52] Blondel, B., Alexander, S., Bjarnadóttir, R.I., et al. (2016) Variations in Rates of Severe Perineal Tears and Episiotomies in 20 European Countries: A Study Based on Routine National Data in Euro-Peristat Project. Acta Obstetricia et Gynecologica Scandinavica, 95, 746-754. [Google Scholar] [CrossRef] [PubMed]
[53] Binfa, L., Pantoja, L., Ortiz, J., et al. (2016) Midwifery Practice and Maternity Services: A Multisite Descriptive Study in Latin America and the Caribbean. Midwifery, 40, 218-225. [Google Scholar] [CrossRef] [PubMed]
[54] Kaddoura, R., DeJong, J., Zurayk, H., et al. (2019) Episiotomy Practice in the Middle East: A Lebanese Teaching Tertiary Care Centre Experience. Women and Birth, 32, e223-e228. [Google Scholar] [CrossRef] [PubMed]
[55] Schantz, C., Sim, K.L., Ly, E.M., et al. (2015) Reasons for Routine Episiotomy: A Mixed-Methods Study in a Large Maternity Hospital in Phnom Penh, Cambodia. Repro-ductive Health Matters, 23, 68-77. [Google Scholar] [CrossRef] [PubMed]
[56] Clesse, C., Lighezzolo-Alnot, J., De Lavergne, S., Hamlin, S. and Scheffler, M. (2018) Statistical Trends of Episiotomy around the World: Comparative Systematic Review of Changing Practices. Health Care for Women International, 39, 644-662. [Google Scholar] [CrossRef] [PubMed]
[57] Amorim, M.M., Coutinho, I.C., Melo, I. and Katz, L. (2017) Selective Episiotomy vs Implementation of a Non-Episiotomy Protocol: A Randomized Clinical Trial. Reproductive Health, 14, Article No. 135. [Google Scholar] [CrossRef] [PubMed]
[58] Franchi, M., Parissone, F., Lazzari, C., Garzon, S., et al. (2020) Selective Use of Episiotomy: What Is the Impact on Perineal Trauma? Results from a Retrospective Cohort Study. Archives of Gynecology and Obstetrics, 301, 427-435. [Google Scholar] [CrossRef] [PubMed]
[59] Radnia, N., Khansari, S., Jiriaei, N., Hosseini, S.A., Salemi, L. and Hamoon, M. (2022) The Relationship between Perineal Size and Episiotomy during Delivery. Journal of Medicine and Life, 15, 1379-1383. [Google Scholar] [CrossRef] [PubMed]
[60] Obstetrics Group, Obstetrics and Gynecology Society and Chinese Medical Association (2016) Clinical Guidelines for Operative Vaginal Delivery. Chinese Journal of Obstetrics and Gynecology, 51, 565-567.