Bland D R, Earle B B, Vitolins M Z, Burke G
Departments of Obstetrics and Gynecology and Public Health Sciences, Wake Forest University School of Medicine.
Am J Obstet Gynecol. 1999 Dec;181(6):1324-7; discussion 1327-8. doi: 10.1016/s0002-9378(99)70371-6.
This study was undertaken to apply the standardized Pelvic Organ Prolapse staging system to perimenopausal women to obtain normative data and to determine any effects of risk factors for incontinence and prolapse on Pelvic Organ Prolapse staging system scores.
Two hundred forty-one women aged 45 to 55 years who were seen for perimenopausal care were evaluated in the dorsal lithotomy position for pelvic prolapse at enrollment and again at 12 months. Prolapse was scored according to the Pelvic Organ Prolapse staging system, as approved by the International Continence Society. All subjects completed questionnaires to obtain demographic data, reproductive history, and gynecologic history. Data were evaluated with the Mann-Whitney rank sum test and with 1-way analysis of variance on ranks.
The subjects had a mean parity of 2.2 and a mean weight of 72.4 kg. Hysterectomy had been performed in 28% of the women. Urinary incontinence was reported by 66% of the women at enrollment. Mean prolapse scores that described the position of the cervix, the position of the posterior fornix, and the total vaginal length were significantly changed by the 1-year follow-up, with scores reflecting increased prolapse. The mean score at point Ba, which represents the proximal portion of the anterior vaginal wall, was significantly lower, consistent with decreased prolapse at this site. History of smoking, prior hysterectomy, weight, parity, and incontinence at enrollment did not significantly correlate with any of the 9 measured prolapse points.
Normative data for the Pelvic Organ Prolapse staging system of the International Continence Society, American Urogynecologic Society, and Society of Gynecologic Surgeons were measured in a group of perimenopausal women. Apparent increases in prolapse at points C, D, and tvl may reflect changes in vaginal size rather an increase in uterine or vaginal vault prolapse. This variability may confound the use of the Pelvic Organ Prolapse staging system in longitudinal studies involving perimenopausal women.
本研究旨在将标准化的盆腔器官脱垂分期系统应用于围绝经期女性，以获取规范数据，并确定尿失禁和脱垂的危险因素对盆腔器官脱垂分期系统评分的影响。
对241名年龄在45至55岁之间接受围绝经期护理的女性，在入组时和12个月后采用膀胱截石位评估盆腔脱垂情况。脱垂情况根据国际尿控协会批准的盆腔器官脱垂分期系统进行评分。所有受试者均完成问卷调查以获取人口统计学数据、生育史和妇科病史。数据采用曼-惠特尼秩和检验和单向秩方差分析进行评估。
受试者的平均产次为2.2，平均体重为72.4千克。28%的女性接受过子宫切除术。入组时66%的女性报告有尿失禁。描述宫颈位置、后穹窿位置和阴道总长度的平均脱垂评分在1年随访后有显著变化，评分反映脱垂增加。代表阴道前壁近端的Ba点平均评分显著较低，表明该部位脱垂减少。吸烟史、既往子宫切除术、体重、产次和入组时的尿失禁与9个测量的脱垂点均无显著相关性。
在一组围绝经期女性中测量了国际尿控协会、美国妇科泌尿协会和妇科外科医生协会的盆腔器官脱垂分期系统的规范数据。C点、D点和tvl点脱垂的明显增加可能反映阴道大小的变化，而非子宫或阴道穹窿脱垂的增加。这种变异性可能会混淆盆腔器官脱垂分期系统在涉及围绝经期女性的纵向研究中的应用。
