孕期排便协同失调对首次阴道分娩时会阴Ⅲ度和Ⅳ度裂伤的影响：一项病例对照研究。

Effect of dyssynergic defecation during pregnancy on third- and fourth-degree tear during a first vaginal delivery: a case-control study.

作者信息

Marchand Marie-Claude, Corriveau Hélène, Dubois Marie-France, Watier Alain

机构信息

Clinical Sciences Program, Université de Sherbrooke, Sherbrooke, Quebec, Canada.

出版信息

Am J Obstet Gynecol. 2009 Aug;201(2):183.e1-6. doi: 10.1016/j.ajog.2009.05.020.

DOI:10.1016/j.ajog.2009.05.020

PMID:19646569

Abstract

OBJECTIVE

Determine whether dyssynergic defecation is a risk factor for third- or fourth-degree tear during a first vaginal delivery.

STUDY DESIGN

A retrospective case-control study was conducted on 549 primiparous women. The case group (n = 140) sustained an anal sphincter tear and the control group (n = 409) had a perineal laceration lower or equal to a second-degree tear. The Knowles-Eccersley-Scott Symptom questionnaire identified women who had dyssynergic defecation. A logistic regression analysis was performed.

RESULTS

Anal sphincter tear were 2.94 times higher for women reporting dyssynergic defecation (P = .002; 95% confidence interval [CI], 1.47-5.88). Odds ratios (ORs) were also significant for forceps (P < .001; OR, 6.90; 95% CI, 3.27-14.59), vacuum extraction (P = .009; OR, 2.36; 95% CI, 1.17-4.76), median episiotomy (P = .009; OR, 2.71; 95% CI, 1.54-4.78), and high infant weight (P < .001; OR, 2.25 for each 500 g increase; 95% CI, 1.69-2.99).

CONCLUSION

Dyssynergic defecation seems to increase anal sphincter tear, but prospective studies are needed to confirm the association.

摘要

目的

确定排便协同失调是否为首次阴道分娩时发生三度或四度会阴撕裂的危险因素。

研究设计

对549名初产妇进行了一项回顾性病例对照研究。病例组（n = 140）发生了肛门括约肌撕裂，对照组（n = 409）会阴撕裂程度低于或等于二度。通过诺尔斯 - 埃克斯利 - 斯科特症状问卷确定有排便协同失调的女性。进行了逻辑回归分析。

结果

报告有排便协同失调的女性发生肛门括约肌撕裂的几率高2.94倍（P = .002；95%置信区间[CI]，1.47 - 5.88）。产钳助产（P < .001；比值比[OR]，6.90；95% CI，3.27 - 14.59）、真空吸引助产（P = .009；OR，2.36；95% CI，1.17 - 4.76）、正中会阴切开术（P = .009；OR，2.71；95% CI，1.54 - 4.78）以及婴儿体重高（P < .001；每增加500克OR为2.25；95% CI，1.69 - 2.99）时，比值比也具有统计学意义。