Leeman Lawrence M, Rogers Rebecca G, Greulich Betsy, Albers Leah L
Department of Family and Community Medicine, School of Nursing, University of New Mexico Health Sciences Center, Albuquerque 87131, USA.
J Am Board Fam Med. 2007 Sep-Oct;20(5):451-7. doi: 10.3122/jabfm.2007.05.060222.
To compare the postpartum pelvic floor function of women with sutured second-degree perineal lacerations, unsutured second-degree perineal lacerations, and intact perineums.
A prospective cohort of nurse-midwifery patients consented to mapping of genital trauma at birth and an assessment of postpartum pelvic floor outcomes. Women completed validated questionnaires for perineal pain and urinary and anal incontinence at 12 weeks postpartum and underwent physical examination to assess pelvic floor strength and anatomy at 6 weeks postpartum.
One hundred seventy-two of 212 (80%) eligible women provided follow-up assessment data at 6 or 12 weeks postpartum. Women with an intact perineum (n=89) used fewer analgesics (P<.002) and had lower pain scores at the time of hospital discharge than women with second-degree lacerations (sutured, n=46; unsutured, n=37; intact, n=89) (P<or=.02). The sutured group was more likely to use analgesics (52%) than the unsutured (35%) or intact (23%) groups at time of hospital discharge (P<.002), although pain scores were not different between sutured and unsutured groups. Postpartum reports of urinary or anal incontinence, sexual inactivity, or sexual function scores did not vary between groups. Weak pelvic floor exercise strength was more common among the women with second-degree lacerations compared with women with an intact perineum (53% vs. 28%; P=.03) but did not differ between sutured (58%) and unsutured (47%) groups (P=not significant). Likewise, perineal body or genital hiatus measurements did not vary between groups (P=not significant).
Women with sutured lacerations report increased analgesic use at the time of hospital discharge compared with women with intact perineums or unsutured lacerations. At 12 weeks postpartum, no differences were noted between groups regarding complaints of urinary or anal incontinence, sexual inactivity, or sexual function.
比较会阴Ⅱ度裂伤缝合、未缝合及会阴完整的女性产后盆底功能。
一项前瞻性队列研究，助产护士的患者同意在出生时绘制生殖器创伤图并评估产后盆底结局。女性在产后12周完成关于会阴疼痛、尿失禁和肛门失禁的有效问卷，并在产后6周接受体格检查以评估盆底肌力和解剖结构。
212名符合条件的女性中有172名（80%）在产后6周或12周提供了随访评估数据。会阴完整的女性（n = 89）使用的镇痛药较少（P <.002），且出院时的疼痛评分低于会阴Ⅱ度裂伤的女性（缝合组，n = 46；未缝合组，n = 37；完整组，n = 89）（P ≤.02）。出院时，缝合组比未缝合组（35%）或完整组（23%）更有可能使用镇痛药（52%）（P <.002），尽管缝合组和未缝合组的疼痛评分没有差异。各组之间产后尿失禁或肛门失禁、性活动减少或性功能评分的报告没有差异。与会阴完整的女性相比，会阴Ⅱ度裂伤的女性中盆底锻炼肌力较弱更为常见（53%对28%；P =.03），但缝合组（58%）和未缝合组（47%）之间没有差异（P =无显著性）。同样，各组之间会阴体或生殖裂孔测量值没有差异（P =无显著性）。
与会阴完整或未缝合裂伤的女性相比，缝合裂伤的女性出院时报告使用的镇痛药增加。产后12周，各组之间在尿失禁或肛门失禁、性活动减少或性功能主诉方面没有差异。
