Present situation and prospect of intervention methods for reducing perineal injury during labor
降低产时会阴损伤干预方法的现状及展望

摘要

临床产妇在经阴道分娩期间很容易造成会阴损伤，而且其中初产妇的会阴损伤程度最为严重，导致原因与自发性以及人为干预有一定的关系。分娩期间如果出现会阴损伤，会造成产妇的大小便失禁、会阴疼痛、出血、感染等并发症发生，甚至远期还可造成产妇盆腔脏器脱垂、性功能障碍等严重的并发症出现。这种情况下，产妇的心理及生理均受到严重影响。对此，本文主要针对性探讨降低产时会阴损伤干预方法的现状及展望。目前，我国关于会阴损伤的相关指南和专家共识还不完善，而美国妇产科医师学会等指南也存在一定的不足。然而，阴道撕裂伤的预防、识别和修复以及阴道器械分娩的管理相对清晰和准确，并提出了明确的建议。我国有必要在循证与国际临床指南相结合的基础上，构建适合我国国情、系统、科学、本土化的会阴管理模式。

Abstract

Clinical parturient perineal injury is very easy to cause during vaginal delivery, and the degree of perineal injury of primipara is the most serious, resulting in a certain relationship with spontaneity and human intervention. If there is perineal injury during childbirth, it will cause maternal incontinence, perineal pain, bleeding, infection and other complications, and even long-term can also cause maternal pelvic organ prolapse, sexual dysfunction and other serious complications. In this case, maternal psychology and physiology are seriously affected. In this paper, the present situation and prospect of intervention methods to reduce perineal injury during labor are discussed. At present, the relevant guidelines and expert consensus on perineal injury in China are not perfect, and the guidelines of the American College of Obstetricians and Gynecologists also have some deficiencies. However, the prevention, recognition and repair of vaginal laceration, as well as the management of vaginal appliance delivery are relatively clear and accurate, and clear recommendations are made. It is necessary for China to construct a systematic, scientific and localized perineal management model based on the combination of evidence-based and international clinical guidelines. Obstetric care providers must respect women's individual differences and choices and select perineal protection techniques based on the best scientific evidence, combined with clinical judgment, to achieve a safe, high-quality natural vaginal delivery.