Development And Clinical Empirical Research On The Episiotomy Essessment Scale During Delivery

Objective:Under the non-medical absolute guidelines,based on the ideas of "restrictive use of episiotomy",to construct of episiotomy assessment tools.Then test its reliability and validity,aiming to provide an effective basis for clinical to reduce the episiotomy rate.Methods:1.Through literature review and qualitative research,using phenomenological theory and Colaizzi content analysis method,we deeply discussed the comprehensive factors of episiotomy and construct the episiotomy assessment tools preliminary.2.After two rounds of expert consulation on Delphi,researchers modified the items of the tool.At the testing stage of the tool,a total of 60 women from maternal and child health care hospital of nanjing were assessed by convenient sampling method for pre test,and the reliability and validity of the scale were tested.A total of 113 women were assessed by convenient sampling method in the study and the reliability and validity of the tool were analyzed again.According to the results of groups by the clinical gold standard diagnosis,drawn receiver operating characteristic curve,the largest Youden index made the best cut-off for episiotomy.3.The tool was applied to the maternal and child health care hospital of qixia district,Nanjing,to explore the effect of the episiotomy evaluation tool on the outcomes of the mother and child.The data obtained from the above investigation were both inputted to SPSS 20.0 for statistical treatment.The measurement data were expressed with mean standard deviation(x ± s),and compared with t test;the count data were expressed as percentage,x2 test was used,rank data were tested by rank sum test,and the difference of P<0.05 was statistically significant,Result:1.Through literature review and qualitative interview,the assessment tool of episiotomy was constructed in 3 dimensions,9 items and 24 scoring criteria.The application standard of the tool was determined and the measurement method and standard of related items were standardized.2.After two rounds of expert consultation on Delphi,the episiotomy essesssment tool consisting of 3 dimensions,8 items and 23 scoring criteria was ultimately formed.The positive coefficient of experts was 100%,authority coefficient was 0.935,two rounds of expert coordination coefficient were 0.457 and 0.510,and the expert coordination degree and synergy of expert opinions were high.Therefore,this study was reliable.3.In the pre experiment,the items of the scale was good,the Cronbach's alpha coefficient was 0.712,the Cronbach's alpha coefficient of the "perineal condition" dimension was 0.730;and the inter-rater reliability was 0.901.The i-cvi of the 8 items ranged from 0.83 to l,and the s-cvi/UA of the scale was 0.875,and s-cvi/Ave was 0.98.When exploratory factor analysis was used to test validity,KMO test and Bartlett spherical test showed that samples were suitable for factor analysis.By using the fixed factor method,3 main factors were extracted and the maximum variance orthogonal rotation principal component analysis was used.The cumulative variance of 3 common factors reached 71.660%,and the load of each factor was more than 0.5.4.After the formal experiment,the items of the scale was good,Cronbach's alpha coefficient was 0.801,the Cronbach's alpha coefficient of the "perineal condition" dimension was 0.909,and the inter-rater reliability was 0.992.When exploratory factor analysis was used to test construct validity,KMO test and Bartlett spherical test showed that samples were suitable for factor analysis,three common factors based on the criteria of Eigenvalues greater than 1 were extracted,and 78.747 percent of the total variation was explained,and the factor load of each item was above 0.7,with goods the structural validity was good.In addition,the scale could be used to distinguish between the two groups of episiotomy and non episiotomy.The discriminant validity was good.5.According to the results of practical investigation of 113 women,drawn receiver operating characteristic curve(ROC).When the cut-off value was 15.5,the largest Youden index was 0.701,and the sensitivity was 94.1%,the specificity was 75.9%,62.70%positive predictive value and negative notice value of 96.8%.The predicted value and discriminant validity of this scale were high.6.We applied episiotomy essessment tool to vaginal delivery women of Maternal and Child Care Hospital of Qixia District.The rate of episiotomy decreased from 42.23%to 33,04%,the difference reached a significant level,and the rate of second degree laceration decreased from 19.33%to 14.94%,and the difference reached a significant level.There was no statistically difference between Apgar score of 1 minute and 5minutes and the amount of bleeding within incision and postpartum hemorrhage of 24hours.Therefore,the tool can reduced the episiotomy rate effectively and had no adverse effect on the mother and baby.Conclusion:The episiotomy essesssment tool included 3 latitudes,8 items and 23 scoring criteria.On the basis of Delphi Method and preliminary test,the tool had good reliability and validity.The predicted value of this scale was high.It is appropriate to use the tool in vaginal delivery women,providing an effective basis for clinical to reduce the episiotomy rate.