在阴道分娩期间预防周围外伤
Nicola Adanna Okeahialam1, Abdul H Sultan2, Ranee Thakar2
1Croydon University Hospital, London, United Kingdom.
American journal of obstetrics and gynecology
|August 27, 2023
概括
围外伤,在阴道分娩中很常见,特别是在第一次母亲身上,可能导致门失禁. 识别风险因素和实施围按摩和熟练的表皮切除术等干预措施可以减少产科关节损伤.
科学领域:
- 产科和妇科 产科和妇科
- 孕产妇和胎儿医学 孕产妇和胎儿医学
- 盆地地板健康 盆地地板健康
背景情况:
- 周围的创伤会影响大多数阴道分娩,而在初生妇女中,二度撕裂很常见.
- 产妇关节损伤 (OASIS) 发生在约3%的阴道分娩中,造成失禁和高医疗成本的重大风险.
- 确定周围创伤的可修改风险因素对于改善临床护理和降低相关发病率至关重要.
研究的目的:
- 审查与阴道外伤相关的风险因素,特别是阴道分娩期间的OASIS.
- 提出基于证据的干预措施,以预防周围创伤和OASIS.
- 突出修改产科实践的重要性,以获得更好的孕产妇结果.
主要方法:
- 对围外伤和OASIS的风险因素的文献综述.
- 对预防产前和产后干预措施的分析.
- 检查当前的指导方针和关于表皮切开术使用的证据.
主要成果:
- OASIS的危险因素包括胎儿出生体重增加,手术性阴道分娩和初级生育.
- 产前围按摩可以提高弹性,减少撕裂.
- 产后干预措施,如对手工保护和选择性中侧表皮切除术 (特别是辅助分娩) 的临床医生培训,可以减少OASIS的发生率.
结论:
- 围外伤是阴道分娩的一个重要问题,OASIS具有长期后果.
- 产前准备 (围按摩) 和产后保护措施 (熟练技术,选择性表皮切割) 的结合是预防的关键.
- 需要进一步的研究和基于证据的实践的实施,以尽量减少围外伤及其相关的发病率.
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