背景:阴道分娩后发生任何形式的会阴损伤的产妇损伤非常常见,全球范围为16.2%至90.4%。产科肛门括约肌损伤的频率和宫颈裂伤的发生率迅速增加。然而,在埃塞俄比亚,关于阴道分娩后产妇产伤的患病率及其决定因素的证据有限。
目的:评估冈达尔大学综合专科医院阴道分娩后产妇分娩创伤的程度和相关因素,Gondar,埃塞俄比亚西北部,2022年。
方法:一项基于机构的横断面研究于2022年5月9日至8月9日在Gondar大学综合专科医院对424名研究参与者进行了单胎阴道分娩的母亲。使用了预先测试的半结构化提问器。Epi-Data4.6版用于数据输入,并导出到SPSS25版进行数据管理和分析。为了确定决定因素,拟合二元逻辑回归模型,并考虑p值<0.2的变量进行多变量二元逻辑回归分析.在多变量二元逻辑回归分析中,P值<0.05的变量被认为与结果变量具有统计学显著关联。据报道,具有95%CI的调整赔率比(AOR)表明产妇出生创伤与自变量之间的统计学意义和关联强度。
结果:共纳入424例阴道分娩的母亲。参与者的平均年龄为26.83岁(±5.220岁)。产妇经阴道分娩后发生产伤的比例为47.4%(95CI:43.1,51.7)。不同形式的会阴创伤,一级撕裂占42.8%,OASIs占1.5%,宫颈裂伤占2.5%。在初产妇的多变量二元逻辑回归分析中(AOR=3.00;95CI:1.68,5.38),分娩时妊娠年龄≥39周(AOR=2.96;95CI:1.57,5.57),出生体重较重(AOR=12.3;95CI:7.21,40.1),头围较大(AOR=5.45;95CI:2.62,11.31),手术阴道分娩(AOR=6.59;95CI:1.44,30.03)和无会阴和/或胎儿头部支持分娩(AOR=6.30;95CI:2.21,17.94)与产妇产伤的存在显著相关.
结论:本研究中阴道分娩后产妇的产伤相对较高。初级奇偶校验,分娩时胎龄超过39周,出生体重较重,更大的头围,手术阴道分娩和无会阴和/或胎头支持的分娩是影响会阴结局的因素。埃塞俄比亚卫生部应定期提供干预培训,以减少产妇的出生创伤。
BACKGROUND: Maternal injury with any form of perineal trauma following vaginal delivery is very common which ranges globally from 16.2 to 90.4%. The frequency of Obstetric anal sphincter Injuries and the incidence of cervical laceration increases rapidly. However, in Ethiopia, there is limited evidence on the prevalence of maternal birth trauma and its determinant factors after vaginal delivery.
OBJECTIVE: To assess the magnitude and associated factors of Maternal Birth Trauma after vaginal delivery at University of Gondar Comprehensive Specialized Hospital, Gondar, North-West Ethiopia, 2022.
METHODS: An Institution based cross-sectional study was conducted among mothers with singleton vaginal delivery at University of Gondar Comprehensive Specialized Hospital from 9th May to 9th August 2022 among 424 study participants. Pre-tested semi-structured questioner was utilized. Epi-Data version 4.6 was used for data entry and exported to SPSS version 25 for data management and analysis. To identify the determinant factors, binary logistic regression model was fitted and variables with p-value < 0.2 were considered for the multivariable binary logistic regression analysis. In the multivariable binary logistic regression analysis, Variables with P-value < 0.05 were considered to have statistical significant association with the outcome variable. The Adjusted Odds Ratio (AOR) with 95% CI was reported to declare the statistical significance and strength of association between Maternal Birth Trauma and independent variables.
RESULTS: A total of 424 mothers who delivered vaginally were included. The mean age of participants was 26.83 years (± 5.220 years). The proportion of birth trauma among mothers after vaginal delivery was47.4% (95%CI: 43.1, 51.7). Of different forms of perineal trauma, First degree tear in 42.8%, OASIs in 1.5% and Cervical laceration in 2.5% study participants. In the multivariable binary logistic regression analysis being primiparous (AOR = 3.00; 95%CI: 1.68, 5.38), Gestational age ≥ 39 weeks at delivery (AOR = 2.96; 95%CI: 1.57, 5.57), heavier birth weight (AOR = 12.3; 95%CI: 7.21, 40.1), bigger head circumference (AOR = 5.45; 95%CI: 2.62, 11.31), operative vaginal delivery (AOR = 6.59; 95%CI: 1.44, 30.03) and delivery without
perineum and/or fetal head support (AOR = 6.30; 95%CI: 2.21, 17.94) were significantly associated with the presence of maternal birth trauma.
CONCLUSIONS: Maternal birth trauma following vaginal delivery was relatively high in this study. Prim parity, gestational age beyond 39 weeks at delivery, heavier birth weight, bigger head circumference, operative vaginal delivery and delivery without
perineum and/or fetal head supported were factors affecting perineal outcome. The Ministry of Health of Ethiopia should provide regular interventional training as to reduce maternal birth trauma.