Dolan Lucia M, Hilton Paul
Directorate of Women's Services, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
Int Urogynecol J. 2010 May;21(5):535-44. doi: 10.1007/s00192-009-1074-8. Epub 2010 Jan 6.
Intrapartum events at first delivery and subsequent childbearing are associated with long-term pelvic floor dysfunction (PFD).
Primigravidae delivered between 1983-1986 were identified; current addresses traced through the UK National Health Service database (N = 3002). Women completed screening and Sheffield Pelvic Floor Questionnaires (Sheffield-PAQ). Maternity data were obtained from Standard Maternity Information System. Primary outcomes were urinary incontinence (UI), anal incontinence (AI), and prolapse (POP).
Primary response was 62.1%; 53.8% (n = 985) had >or=1 PFD symptom and in 71.5% symptoms were bothersome. UI (OR 0.47 95% CI 0.28, 0.81) and fecal incontinence (FI; OR 0.32 95% CI 0.13, 0.77) risks were lower after first delivery by cesarean section (CS). However, 25% had UI and 12% had FI after delivering exclusively by CS. Obesity was a risk factor independent of obstetric history.
CS provides incomplete or poorly sustained pelvic floor protection by middle age. Obese women were at highest risk and had the most severe symptoms.
首次分娩及后续生育过程中的产时事件与长期盆底功能障碍（PFD）相关。
确定1983 - 1986年间分娩的初产妇；通过英国国家医疗服务数据库追踪其当前地址（N = 3002）。女性完成筛查及谢菲尔德盆底问卷（Sheffield - PAQ）。从标准产妇信息系统获取产妇数据。主要结局为尿失禁（UI）、肛门失禁（AI）和盆腔器官脱垂（POP）。
主要应答率为62.1%；53.8%（n = 985）有≥1种PFD症状，且71.5%的症状令人困扰。首次剖宫产（CS）分娩后，尿失禁（OR 0.47，95% CI 0.28，0.81）和大便失禁（FI；OR 0.32，95% CI 0.13，0.77）风险较低。然而，仅通过剖宫产分娩后，25%的女性有尿失禁，12%的女性有大便失禁。肥胖是独立于产科病史的危险因素。
到中年时，剖宫产对盆底的保护不完整或维持不佳。肥胖女性风险最高且症状最严重。
