Gomman H M, Nossier S A, Fotohi E M, Kholeif A E
Department of Family Health, High Institute of Public Health, Alexandria University.
J Egypt Public Health Assoc. 2001;76(5-6):313-35.
Most hospital-based studies on genital prolapse focus on the contribution of prolapse to the overall hospital incidence rate of hysterectomy. The present study targeted the outpatient clinic of a teaching and reference hospital (The Maternity University Hospital in Alexandria) to determine the prevalence and possible factors associated with genital prolapse among the attendants of the gynecological outpatient clinic. Through a cross sectional approach, a systematic random sample of 400 women (being non-pregnant, age 25 years and over), was selected from the outpatient clinic over a period of 6 months. They were subjected to: 1) a structured interview using a questionnaire, 2) clinical examination, and 3) measurement of body mass index (BMI). Pelvic examination revealed a high prevalence rate, moderate and large degrees were present in 40% of them. Cysto-rectocele was the commonest type (65.5% of the whole sample), followed by utero-vaginal prolapse (3.5%). The most commonly reported complaints (89.9%) were not related to genital prolapse. Symptoms specific to prolapse were reported on inquiry by a small proportion of cases (25.8%). Comparing women's report and diagnoses indicated a low sensitivity (33%) and very high specificity (100%). Stress incontinence and multiple sexual consequences were the most frequently reported complications (60.1% and 66.7% respectively). Stepwise logistic regression analysis revealed that five variables only were significant predictors of prolapse: parity 3+ (p = .0001, CI = 1.67-5.25), unskilled birth attendant (p = .0006, CI = 1.2-3.2), prolonged labor (p = .007, CI = 1.7-7.6), early resumption of routine activities during puerperium (p = 002, CI = 1.7-11.3) and history of obvious weight loss (p = .0026, CI = 1.19-17.2). The presence of many silent cases of prolapse among outpatients in spite of having moderate and severe degrees indicates that health education on different aspects of reproduction is highly required to encourage women to know and report their sufferings. Improving the skills of birth attendants, focussing on domiciliary obstetrics is also emphasized.
大多数基于医院的生殖器脱垂研究都聚焦于脱垂对子宫切除总住院发病率的影响。本研究以一家教学及参考医院（亚历山大妇产大学医院）的门诊为对象，以确定妇科门诊就诊者中生殖器脱垂的患病率及相关可能因素。通过横断面研究方法，在6个月的时间里从门诊中系统随机抽取了400名女性（非妊娠，年龄25岁及以上）。她们接受了：1）使用问卷进行的结构化访谈；2）临床检查；3）体重指数（BMI）测量。盆腔检查显示患病率很高，其中40%存在中度和重度脱垂。膀胱直肠膨出是最常见的类型（占整个样本的65.5%），其次是子宫阴道脱垂（3.5%）。最常报告的主诉（89.9%）与生殖器脱垂无关。一小部分病例（25.8%）在询问时报告了脱垂特有的症状。比较女性的报告和诊断结果显示敏感性较低（33%），特异性非常高（100%）。压力性尿失禁和多种性方面的后果是最常报告的并发症（分别为60.1%和66.7%）。逐步逻辑回归分析显示，只有五个变量是脱垂的显著预测因素：产次3次及以上（p = .0001，CI = 1.67 - 5.25）、非熟练助产士接生（p = .0006，CI = 1.2 - 3.2）、产程延长（p = .007，CI = 1.7 - 7.6）、产褥期过早恢复日常活动（p = 002，CI = 1.7 - 11.3）以及明显体重减轻史（p = .0026，CI = 1.19 - 17.2）。尽管存在中度和重度脱垂，但门诊中有许多无症状脱垂病例，这表明非常需要开展关于生殖各方面的健康教育，以鼓励女性了解并报告她们的痛苦。同时也强调要提高助产士的技能，关注家庭产科。
