| Objective To construct indicator systems of different modes for perineal protection Methods This research methods are four aspects in order, including Expert consultation by the expert-group focus interviews,amending indicators by clinical trials, as well as specialist certification and clinical applications by non-randomized control experiments.Results Intrapartum comprehensive evaluation index system is consist of 5 first-grade-assessment-indicators (FGAIs),7 secondary-grade-assessment-indicators (SG AIs) and 27 third-grade-assessment-indicators (TGAIs).The FG AI of "perineal conditions" is made up of 5 SGAIs including "length" "flexible" "color" "thickness" and "inflammation". There are 3 TGAIs of "<3cm" "> 7cm" and "3-7cm" included in "length",3 TGAIs of" poor" "Normal" and " good " included in "flexible",3 TGAIs of "pale and shiny" "flushing" and "dark" included in "color",3 TGAIs of "hypertrophy" "normal" and "thin" included in "thickness",2 TGAIs of "yes" and "no" included in "inflammation". The FGAI of "fetal condition" is made up of 2 SGAIs s including "size" and "fetal position". There are 3 TGAIs of "> 3500g" "3000-3500g" and "<3000g" included in "size",2 TGAIs of "abnormal fetal position including occiput transverse position and posterior position" and "normal fetal position as well as anterior position " included in " fetal position". Another FGAI is "cooperation", which are formed by 3 FGAIs of "irritability and abdominal pressure cannot be used effectively with the midwife" "anxiety and abdominal pressure can be used effectively with the midwife" and "emotional stability and abdominal pressure can effectively be used with midwife". The FGAI of "uterine action" is matched with 3 TGAIs of "too weak" "too strong" and" moderate". The last FGAI of "perineal protection intentions" is matched with 2 TGAIs of "require episiotomy" and "hard protection or assessment under circumstances by midwife".Experts assigned for each TGAI and identified the scoring range different modes of perineum protection. In addition, experts also identified perineum protection of the exceptions during delivery including premature birth, fetal distress and amniotic serious pollution. Comprehensive assessment score for the mothers of non-episiotomy ranged from 14 to 24points, if it is urgent production, then the composite score ranged from 16 to 24 points; Comprehensive assessment score for the mothers with median perineum incision ranged from 12 to 13 points. The indicators of mothers for carrying out 30° lateral episiotomy were refers to prematurity, intrauterine growth retardation or the comprehensive assessment score ranged from 8 to 11 points. The indicators of mothers for carrying out 45° lateral episiotomy perineum included pregnancy with heart disease, pregnant women with severe hepatitis, intrahepatic cholestasis of pregnancy (ICP), gestational diabetes mellitus (GDM require drug treatment), pregnant women with eclampsia, forceps, second stage of labor prolonged, huge children, fetal distress, amniotic severe pollution, radical production (comprehensive assessment of 0-15 points), and comprehensive assessment of maternal between 0-7 points.The clinical application of indicators system were carried out in 649 cases of maternal with normal delivery. Among them, there were 640 cases in accordance with the judgment and the mode of perineal protection referred to the indicators system, and only 9 cases of failing to perform the appropriate perineal protection. The evidence showed that the indicators system was in good clinical applicability.Non-random controlled trials showed that the application of the indicators system could reduce episiotomy rate and decrease the average bleeding during production. Meanwhile, the application of the indicators system could not increase the incidence of severe perineal tears and also not increase the incidence of intrapartum injury.Conclusion The indicators system for perineal protection built in this research showed good feasibility and clinical applicability withinpuerpera. |
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