ObjectiveTo assess the association between the decrease in the use of episiotomy and the incidence of obstetric anal sphincter injuries (OASIS) over a 10‐year period and understand their reasons by interviewing obstetricians and midwives.DesignMixed‐methods study.SettingA tertiary university public maternity hospital, Paris, France.PopulationAll patients who delivered vaginally between January 2012 and December 2021 in the maternity hospital and 20 interviews with obstetrician‐gynaecologists and midwives.MethodsQuantitative data analysis using a multivariate logistic regression model, stratifying on the mode of delivery. Semi‐structured interview with 20 obstetricians and midwives, with an interview guide.Main Outcome MeasuresObstetric anal sphincter injuries.ResultsThe quantitative study of 37 942 women (16.1% of whom had an episiotomy and 1.4% OASIS) shows that, the incidence of episiotomy decreased from 25% to 7.6% over this 10‐year period. Allow on the known risk factors for OASIS, we demonstrate that its incidence rose (adjusted odds ratio 1.35, 95% confidence interval 1.09–1.67) for the years in which the episiotomy incidence fell below 10% for the overall population. The interviews showed professionals' apparent awareness that the decreased incidence in episiotomy (achieved by changes in departmental policy, redefining its benefit/risk balance and acquiring new skills to manage the expulsion phase) could lead to an increased incidence of OASIS.ConclusionsDecreasing the episiotomy incidence appears to be associated with a rising incidence of OASIS. The optimal incidence of episiotomy remains controversial in the literature and among professionals.

中文翻译：

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会阴切开术发生率和产科肛门括约肌损伤 10 年演变：一项混合方法研究


目的评估 10 年期间会阴切开术使用减少与产科肛门括约肌损伤 （OASIS） 发生率之间的关联，并通过采访产科医生和助产士了解其原因。DesignMixed‐methods study.地点法国巴黎市三级大学公立妇产医院人口 2012 年 1 月至 2021 年 12 月期间在妇产医院阴道分娩的所有患者，以及对妇产科医生和助产士的 20 次采访。方法使用多变量 logistic 回归模型进行定量数据分析，对交付方式进行分层。对 20 名产科医生和助产士进行半结构化访谈，并附有访谈指南。主要结局指标产科肛门括约肌损伤。结果对 37 942 名女性（其中 16.1% 进行了会阴切开术，1.4% 进行了 OASIS）的定量研究表明，在这 10 年期间，会阴切开术的发生率从 25% 下降到 7.6%。考虑到 OASIS 的已知危险因素，我们证明在会阴切开术发病率低于 10% 的年份，其发病率上升 （调整后比值比 1.35,95% 置信区间 1.09-1.67）。访谈显示，专业人员明显意识到会阴切开术的发生率降低（通过改变部门政策、重新定义其收益/风险平衡并获得管理驱逐阶段的新技能来实现）可能导致 OASIS 的发生率增加。结论会阴切开术发病率的降低似乎与 OASIS 发病率的增加有关。会阴切开术的最佳发生率在文献和专业人士中仍然存在争议。