阴道分娩与盆腔器官脱垂之间的关系。

Relation between vaginal birth and pelvic organ prolapse.

作者信息

Sze Eddie H M, Hobbs Gerry

机构信息

Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics, Gynecology, & Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06520, USA.

出版信息

Acta Obstet Gynecol Scand. 2009;88(2):200-3. doi: 10.1080/00016340802596033.

DOI:10.1080/00016340802596033

PMID:19089783

Abstract

OBJECTIVE

To evaluate the relation between vaginal birth and pelvic organ prolapse quantification (POPQ) stages III and IV prolapse and whether each additional vaginal birth is associated with an increase in pelvic support defects.

DESIGN

Prospective cross-sectional study.

SETTING

Gynecology clinic in a University Hospital.

POPULATION

Four hundred and fifty-eight nulliparas and 892 multiparas, including 272 with one, 299 with two and 321 with at least three term vaginal deliveries.

METHODS

In a Human Investigation Committee approved-study, the pelvic support of nulliparas and multiparas who only had term vaginal deliveries was evaluated for prolapse using the POPQ system.

MAIN OUTCOME MEASURE

Difference in POPQ stages III and IV prolapse between nulliparas and multiparas. 2. Difference in POPQ stage distribution among nulliparas and multiparas who had one, two, and at least three term vaginal deliveries.

RESULTS

Compared with nulliparas, the odds ratios of having POPQ stage II defect and stage III or IV prolapse associated with multiparas was 2.95 (95% CI: 2.06-4.24) and 1.01 (95% CI: 0.40-2.79), respectively. The prevalence of POPQ stage II defect among nulliparas and multiparas that had one, two, and at least three term vaginal deliveries was 25% (119/458), 50% (137/272), 66% (198/299), and 69% (220/321), respectively (p<0.001), while 1% (6/458), 1% (4/272), 2% (7/299), and 2% (8/321), respectively, had POPQ stage III or IV prolapse (p=0.618).

CONCLUSIONS

Vaginal birth is not associated with POPQ stages III and IV prolapse, but it is associated with an increase in POPQ stage II defect.

摘要

目的

评估经阴道分娩与盆腔器官脱垂定量分期（POPQ）III期和IV期脱垂之间的关系，以及每增加一次经阴道分娩是否与盆腔支持结构缺陷增加相关。

设计

前瞻性横断面研究。

地点

大学医院的妇科门诊。

研究对象

458例未产妇和892例经产妇，其中包括272例有1次、299例有2次以及321例至少有3次足月阴道分娩的经产妇。

方法

在一项经人类研究委员会批准的研究中，使用POPQ系统对仅经历过足月阴道分娩的未产妇和经产妇的盆腔支持结构进行脱垂评估。

主要观察指标

未产妇和经产妇之间POPQ III期和IV期脱垂的差异。2. 有1次、2次以及至少3次足月阴道分娩的未产妇和经产妇在POPQ分期分布上的差异。

结果

与未产妇相比，经产妇出现POPQ II期缺陷以及III期或IV期脱垂的比值比分别为2.95（95%可信区间：2.06 - 4.24）和1.01（95%可信区间：0.40 - 2.79）。在有1次、2次以及至少3次足月阴道分娩的未产妇和经产妇中，POPQ II期缺陷的患病率分别为25%（119/458）、50%（137/272）、66%（198/299）和69%（220/321）（p<0.001），而POPQ III期或IV期脱垂的患病率分别为1%（6/458）、1%（4/272）、2%（7/299）和2%（8/321）（p = 0.618）。