The Comparative Study Of Restrictive And Non-restrictive Episiotomy In The Natural And Head Delivery

Objective To study the influences of restrictive episiotomy(RE) in a single, head and natural delivery for primiparas including normal weight infant and macrosomia in these respects:the rates of perineal laceration and episiotomy, the rate of neonatal asphyxia, the labor time of second stage, the amount of blood loss in2hours after delivery, the time to get out of bed, wound pain, wound swell, patient satisfaction, pelvic floor muscle strength on the42th day.MethodsPart One To select primiparas543cases in the meternal and child care hospital of Gansu Province(GSMCH) from2012.5to2012.7as the observation group, the production process was observed and the fetal heart was monitored, while both sides of the pudendal nerve block anesthesia and vitamin AD drops vaginal lubrication method were used and techniques confinements improved, and try not to episiotomy; to select primiparas500cases in Delivery Center of GSMCH from2010.1to2010.4as the control group, carrying out traditional delivery method with un-limited routine episiotomy when delivery. A retrospective case control study was made between two groups.There were no differences in the age, height, and fetal weight between the two groups. Inclusion criteria:single birth, head, full term, natural birth mothers and their newborn babies; No more serious pregnancy complications, physicians and complications; no birth canal abnormality.The rates of perineal laceration,episiotomy and neonatal asphyxia, the labor time of second stage, the amount of blood loss in2hours after delivery, the time to get out of bed, wound pain, patient satisfaction, pelvic floor muscle strength on the42th day are compared between two groups.Part Two To select primiparas74cases and84cases who deliveries amacrosomia from2010.1to2010.12and from2012.1to2012.12as the observation group and the control group in the GSMCH.To analyze the rendings of perineum including perineal laceration and episiotomy, the rate of neonatal asphyxia, birth injury of newborn babys. There are no differences in the age, height, fetal weight between the two groups. Inclusion criteria:single birth, head, full term, natural birth mothers and their newborn babies; No more serious pregnancy complications, physicians and complications; no birth canal abnormality.Part Three To collect primiparas600cases from2013.10to2013.12in a natural and single delivery.Among600cases,192cases were line episiotomy (incision group), natural laceration were408cases (laceration group), filling in homemade maternal questionnaire respectively. The time to get out of bed, postpartum wound pain and swelling and patient satisfaction are observed between two groups.There was no obvious change among the midwives in the MHC in this period.Results1. The rates of episiotomy,integrity, first-degree and second-degree of perineal laceration were significantly different between two groups. There was no difference about third-degree of perineal laceration. The fourth-degree of perineal laceration not happened between two groups;2. The rates of mild neonatal asphyxia were not different between two groups. The serious neonatal asphyxia not happened;3. There were no differences about the the labor time of second stage and the amount of blood loss in2hours after delivery between two groups;4. The two groups’pelvic floor muscle strength on the42th day were not different;5. The rate of episiotomy carrying out RE was significantly lower than the control group about macrosomia. The rates of mild neonatal asphyxia were not different between two groups. The serious neonatal asphyxia and birth injury of newborns not happened;6. The incision group and laceration group’satisfaction, the time to get out of bed, wound pain, wound swell, pelvic floor muscle strength on the42th day had obvious differences.Conclusions1. There were no obvious adverse effects to the second stage of labor, the rate of neonatal asphyxia, the amount of blood loss in2hours after delivery, pelvic floor muscle strength on the42th day and other indicators to carry out RE; At the same time, the rate of serious perineal laceration is not increased. So we can see RE is relatively safe;2. RE made the rate of episiotomy dropped significantly, so the maternity satisfaction is increased, mothers could get out of bed early, perineal pain significantly reduced, and the hospital gets a good social reputation.